A New Battle

I intend this blog to be a recounting of my adventures in retirement, and random observations about my universe that others might find interesting.  I don’t want it to become a recounting of my medical travails – I get enough of that sitting around beers at O’Malley’s Irish pub with my like-wise retired friends.  But, I do feel it desirable to share with my blog readers my current condition, since it will probably alter my life significantly going forward.  Besides, I am too lazy to recount the story to each and everyone of my friends and acquaintances when the subject inevitably arises – so hopefully most of them will read this.  I will be giving you the Reader’s Digest addition.  I am happy to recount the gritty details to anyone interested, but you might have to show up to O’Malley’s for that.

Upon my return from Nepal, having fully recovered from my bout with altitude sickness in Nepal, I awoke up one morning with moderate to severe stomach pain.  I endured it for the entire day before giving in and driving myself to the hospital.  I spent the late

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Well, I had to have a picture….These are what a typical neuroendocrine tumor looks like on a cellular level. 

night and early morning hours undergoing a battery of blood tests and scans.  A CT scan revealed a soft-tissue mass on my mesentery. In case you didn’t know, the mesentery is the connective tissue that keeps your intestines from falling into a tangled pile around your ass hole.  I was given two rounds of morphine, which resolved the pain. A needle biopsy was scheduled, then delayed then scheduled again and finally happened on April 30.  The final results took another 2 weeks, but it was confirmed that the tumor was a neuroendocrine tumor, which on the realm of good news/bad news is closer to the good news end.

In order to determine if the cancer has spread, I went to Bangkok and was injected with radioactive gallium 68 and had a fancy PET/CT scan.  The injection arrived in a huge lead box, and the hypodermic was shielded by a large lead cylinder.  Yikes!  The scan showed a possible small tumor in a lymph node near my neck and my prostate lit up on the scan suggesting either a tumor there or prostatitis.  This means that the tumor had metastasized.

A bit about this kind of rare tumor.  They normally grow very slowly as mine is (good) but metastasize easily (bad). The location of the tumor on my mesentery is almost 100% likely to be a metastatic tumor, not the original tumor.  In many cases (like mine), the original tumor is never found.  For now, the treatment I have been prescribed is designed to control the growth and spread of the cancer (although there is a 10% chance the treatment will shrink the tumor.  If completely removing the cancer by resection is not possible, then there is quite simply no cure, only control.  Fortunately, several lines of treatment are now available to control these tumors, and many patients live a long time.  So I apparently have incurable but NOT terminal cancer.  The goal is to control it so well that something else gets me first.

On July 5, I had my first injection of sandostatin LAR, a synthetic hormone that attaches itself to neuroendocrine tumors and inhibits their tendency to grow and metastasize.  These injections are not chemotherapy (chemo only works on fast growing cancer).  The side effects are not fun, but nowhere near as bad as having chemo.  I will have 2 more injections 28 days apart followed by another radioactive PET scan in Bangkok.  I am also in the process of obtaining an online second opinion through the MyConsult program at the Cleveland Clinic.

So that’s where I stand for now.  Other then the side-effect of digestive problems, I feel pretty good.  As soon as I can wander farther that 50 m from a toilet, I will resume my jogging program – I am even thinking of trying another marathon down the road.  So life goes on, but my perspectives are evolving rapidly.

Dingboche

Written on March 17 USA time…

I had another miserable night last night, triggered I guess by the altitude gain and the urine productIon caused by the diamox. I think I only had about 2 hours of sleep. I also saw a return of the irregular breathing issue I had back in Namche Bazar. I was happy when dawn came, but I was exhausted. My appetite was gone too.

Nevertheless, I geared myself for the morning acclimatization hike, up the adjacent mountain about 250 m. I joined the procession of a couple of hundred trekkers snaking up the mount under a bright sun and stiff frigid wind. I forced myself to keep going, resting every one hundred steps. Counting my steps kept my mind off my misery. After reaching the turn-around point marked by a cairn supporting a prayer flag, we turned around and had an incredible view of Lhotse, Makalu (over 8000 m), and Ama Dablam towered over us across the village of Dingboche.

Here are some pictures from our view point:

 

After the brief photo op, our decent was quick. I sat in the dining room of the lodge in near total exhaustion. My lunch came, but I had little appetite. Still, I forced my self to eat the entire bowl of Sherpa stew. It took me nearly an hour to finish it, then I staggered back to my room, which had warmed in the sun, and crawled beneath my sleeping bag. I fell asleep within minutes, and slept soundly for 2 hours. That was my longest sleep since Namche, and also the longest I have gone without peeing. I felt much better after the nap. I spent the rest of the day hanging out in the lodge dining room in front of the yak poop oven, talking with the other trekkers.

If I can get a decent sleep tonight, I will move up the trail, otherwise I will spend an extra day here. Everest base camp is only a two days march from here, but the air gets thinner. Tomorrow morning will be decision time.

Hiking in the Jungle

Almost to the date, 32 years ago, I set out on a 3+ week trek around Annapurna, in the Himalayas Mountains of Nepal.  Next week, I will return to Nepal to begin a 3+ week trek to Everest Base Camp, with a side trip to Gokyo Lakes.  To make this new trek even more fun, I will begin my walk from Jiri instead of flying into Lukla.  This will add an additional week to the trek as I hike the original approach to Namche Bazaar, the gateway to the Everest region.

During that first trek so long ago, I trained by lying in the sun, drinking beer, and otherwise cavorting around Thailand for three weeks before arriving in Kathmandu.  My now 62 year old lungs and legs would have little chance in Nepal if I followed the same training regime this time around.  So, for the last few weeks, I have been hiking the jungle trails up and down Chiang Mai’s Doi Suthep – Doi Pui Mountain.

From Chiang Mai city, Doi Suthep Mountain appears as a large completely forested hulk, with the famous Doi Suthep Temple perched on a promontory about 2000 feet up.  The temple is serviced by a well-travelled, paved road plied by fleets of buses, fans, and songtaews that ferries 1000’s of tourists up to the temple every day.  Only a handful of people take the direct route, up the walking trail.  The first part of the trail, known as the monk’s trail, begins at the mountain’s base, and proceeds up to a lesser known temple, Wat Pha Lat, perched about 700 ft above the trailhead.

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A trail-side shrine at Wat Pha Lat

From there, the “trail” makes a direct beeline for Doi Suthep temple sans switchbacks.  This being the dry season in Thailand, the trail consists of a series of steps stomped into the hard clayey soil.  During the rainy season, I imagine that the trail would make a great muddy waterslide; temple to trailhead to hospital in 5 minutes!

I have now been up and down this trail many times – I know every root and rock along the way – I’m pretty sure I could navigate the trail blindfolded.

Yesterday, as an alternative, I chose a very lightly used trail that diagonals up the mountain toward the northwest to the small hill-tribe village of Ban Khun Chang Kian (บ้านขุนช่างเคี่ยน) a small settlement spilled across a high ridge about 3000 ft above the City.

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Your grizzled hero at Ban Khun Chang Kian

The trail is mostly used by mountain bikers who get hauled up the mountain in the back of pick-up trucks, and then come tearing down the trail, hikers beware.  I also saw a couple of crazy farang trail runners – not many hikers though,  mostly the trail is empty and quiet.

From the village, I traversed about 9 km south to Doi Suthep temple, following a four-wheel drive road that led eventually to a poorly maintained trail.  The first part of the traverse passed by numerous strawberry fields that thrive in the cooler mountain-top environment.  Trail finding was a bit of a challenge – the jungle hides a spider’s web of jeep trails and walking paths going every-which-way.  After climbing over what seems like 100s of fallen trees, I arrived at the bustle of Doi Suthep and descended the steep trail to just above Wat Pha Lat, where I finished the 20 km long hike with a 3 km traverse back to my parking spot along the Doi Suthep road.

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Terraced strawberry fields forever

Hiking this trail gave me a great workout – the distance and elevation gain probably equals or exceeds any day-long segment I will encounter in Nepal (albeit at low altitude).  The trails are pleasant enough, although quite steep in places.  During the dry relatively cool season (temps in the upper 80s- low 90s F) the cooler temperatures up high are pleasant. There were only two real downsides to this hike.  One was the constant cloud of kamikaze gnats that enveloped my head.  These terrorists had a penchant for exploring any orifice of mine they could find, and apparently they thought my eyes were portals to a bug’s paradise.   I spent much of the hike wondering if the swarm consisted of the same 200 bugs who found me at the trailhead and followed me for 20 km, or whether they were a tag-team outfit that each had their own designated section of trail.  I imagined attaching a nano GPS transmitter to a few of the gnats to answer this question.  Such are the thoughts that occupy my feeble brain when my legs and lungs are on autopilot.

The second downside was the 20-30 inevitable spider-web-face-plants.  A face-first meeting with this guy will get your attention!

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I am hopeful that these forays into the Thai jungle will amply prepare me for the hiking in Nepal.  My next post will likely be next week from Nepal….

Why I Retired in Thailand

Why did I choose to retire here in Thailand?  This is a question I am asked often by my American friends – especially those who think I actually live in Taiwan.   Of course there are very many reasons; my decision to retire here was not taken lightly and took many years to formulate.  But the story of my day today serves as a great illustration of why I retired half-way around the world from where I lived for 59 1/2 years.

Actually, the story of today began yesterday morning. As I was eating my green curry and rice for breakfast I had that familiar feeling of a foreign object in my mouth….a crown that covered an upper molar had dropped off into my soup (yeah it has happened before). I fished it out and placed into a baggy,  finished by breakfast, then called the dental clinic at Bangkok Hospital (Chiang Mai branch).

Bangkok hospital is the nicest hospital I have ever been in – far better than any I have been in in the USA.  The ambiance is that of a five star hotel.  You are treated as an honored guest and the facilities (as far as I can tell) are world class.  My call  yesterday morning was answered promptly and in perfect English.  They wanted me to come in straight away, but I opted for the next day (today).  I wasn’t going to let a missing molar mess with my regular Thursday golf outing.

Back to today…I arrived at the appointed time at the hospital and entered their large parking lot where a uniformed attended directed me to an open spot.  As he guided me in, he noticed that my tire looked flat.  He looked closer and noticed the bolt that I had picked up that was slowly but surely releasing the tire’s air.  Shit… when things start going wrong you wonder where it will stop.  I didn’t wonder long though, the attended said not to worry, he would see to it that my tire was changed while I was in seeing the dentist.

Up I went to the 4th floor dental clinic where I had to wait about 90 seconds before being ushered into the examination room.  I ask my American friends: whens the last time you waited for only 90  seconds in and doctor’s office?  The dentist happened to be the same as had just cleaned my teeth a few days before.  She took one look and said “no problem”.  Within 15 minutes my crown was glued back in place.  I had to wait another 5 minutes while they tallied up the bill – the princely some of 1070 baht – about $34 US.  My Thai friends would be shocked at this extravagant price – the same service might be half this much elsewhere.  Such is the cost of luxury here.

When I returned to my car, the flat had been changed and the attendant rushed over to give me my keys.  I asked “how much”, and he shook is head and waived his hands.  I tried to force a tip on him, but he ran off saying helping me  was part of the hospital security service.  No need for AAA here.  I still need to fix my tire because I only had a donut spare – fortunately there was a “Cockpit” tire store 200 m down the road.  It took them 10 minutes to fix the flat with a plug and change out the spare.  My cost?  120 baht or $3.80.

Thirty minutes later I was having lunch with my SO at small cafe – we like to try new restaurants whenever we can.

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Pad Thai at Ombra the Garden

I awoke that day in dread of having to get a new crown (or worse) and having to spend a couple of hours in the dentist chair and the rest of the day with a numbed face.  My dread increased when I saw the flat tire.  What next?  But the Thai’s have a wonderful way of making life easy.  Days like this (i.e. most days) make me happy about my retirement choice.