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!

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.