Odd news

My brother called me a few days before Thanksgiving and said that he had some odd news from his doctor’s visit. He had been having some back pain which had moved around to his abdomen. He thought it might be a kidney stone, which he had had before. He had a regular checkup scheduled, so when he told his doctor about it, the doctor ordered an ultrasound.

As you probably know, technicians who perform tests like ultrasounds are seldom willing to tell you anything, but in this case, she mentioned that there were a lot of spots on his liver, something my brother had, I think, also noticed. My brother left without a definitive diagnosis. Doctors’ notes are often available online these days, so my brother checked on his.  The notes referred to metastatic cancer of the liver of unknown origin. The likely sources of cancer that has metastasized to the liver are the prostate, the colon, and the pancreas. My brother’s prostate numbers were good, and his three-year-old colonoscopy was clear. That left one dreadful possibility — the cancer had spread from the pancreas.

Still, the results of an ultrasound aren’t definitive. My brother found some more benign possibilities to explain the spots on the liver, which he told me about. We essentially agreed to withhold our own judgement until any other possibilities were eliminated, but I think both of us knew there was only a slim hope.

My brother told me and his wife about the finding, but he did not tell his two sons. The holidays were almost on us, and his younger son was getting married on December 1 in Washington, DC. My brother was to perform the wedding ceremony. He did’t want to ruin Thanksgiving or the wedding, so he decided to wait till afterwards.

Leah and I went up to Chattanooga for Thanksgiving with my brother, his wife and her family, and my brother’s older son. My brother and I went out to his newly completed garage/workshop, ostensibly to let him show me around, which he did.  He showed me the dust filtration system he had installed with amused irony.

My brother is an ordained Presbyterian minister, but he was a scientist long before he became a minister, and once a scientist, always a scientist. I, too, am a scientist. Not the scientist my brother is, but my outlook is shaped by it, and wishful thinking is not one of the traits generally associated with scientists.

So, how do two brothers who are also scientists discuss a diagnosis of metastatic pancreatic cancer? Once we both have done all the online reading and seen the prognosis? Matter of fact, with an underlying note of frustrated disbelief. It’s like getting the results of an experiment that are not what you expected or hoped for — you might not like it, but that feeling has nothing to do with anything.

The wedding went off well, although Leah and I couldn’t attend. In the meantime, two CT scans showed the extent of the cancer. All but one lobe of his liver had tumors, and his lungs showed a few small spots. There was a small spot in the pancreas, which a biopsy showed to be the source of the metastasized tumors.

As it happens, pancreatic cancer is a bastard. The only actual cure is to catch the cancer before it spreads and, if it’s accessible to surgery, remove it. Unfortunately, pancreatic cancer often spreads with few or no symptoms, so it is generally — almost always — detected only after it has spread. There are no routine screening techniques to detect pancreatic cancer, and the pancreas itself is buried in the abdomen so deeply that it’s difficult, if not impossible, to do something like palpate it. Pancreatic cancer tumors also have an outer layer that makes it hard to get chemo into the tumors. So, pancreatic cancer does its best to cover all the bases.

The Memorial Sloan Kettering Cancer Center website says this: “Despite decades of research, the prospects remain bleak for those diagnosed, with a survival rate of 20% at one year and 6% at five years for all stages combined. Even patients diagnosed and treated at the earliest stage have a 50% chance that the disease will recur.”

I feel like I’m betraying my brother to conclude that his outlook is bleak, indeed, but those are the facts, and, as Joe Friday said, “All we want are the facts, ma’am.”

He’s undergoing chemotherapy, despite the fact that everyone involved expects limited results. His first session knocked him on his back, literally. The first dose of chemo was very strong. The dose was reduced for the next sessions. Now, with a few sessions under his skin, he’s lost enough hair that he shaved the rest off.

Most people know about hair loss from chemotherapy. Many know about things like nausea. I knew about those things. Leah suffered some of the nausea from her chemotherapy way back when she had her colon cancer. But all through those days and right up until recently I never actually knew why it happens. Here’s why:

Chemotherapy targets rapidly dividing cells, which cancer cells certainly are. Unfortunately, there are a number of normal cells in the human body that divide rapidly, including those in hair follicles, those in the linings of the mouth, throat and digestive tract, and those in the bone marrow responsible for making blood cells. That means chemo attacks those cells as well as the cancer cells, resulting in all the side effects we expect from chemo.

The fact is that routine cancer treatment, even today, remains primitive and crude. We try to kill the cancer cells with radiation and chemicals which also damage normal cells, and we hope the treatment is not worse than the disease. I think it’s at least kind of fair to say that the only sure cure for any cancer is to cut it out before it spreads. There are some experimental approaches that seem hopeful and far less crude. Sometimes they are very effective and sometimes they are not; the researchers can’t predict who will respond and who won’t.

My brother remains stoic, or fatalistic, or, maybe just realistic about the matter. He’s hoping for a long enough period of reasonably comfortable survival to finish a piece of furniture he wants to build for his son and his new daughter-in-law. He’s looking at clinical trials, some of which offer the possibility for a somewhat longer survival if the right conditions are met. His church friends are praying for him; maybe he is, too. But he’s neither asking for nor expecting a miracle, and neither am I.


Cold snap

We are in the midst of what we in the deep South call very cold weather. It was 11F (almost -12C)  Sunday night and then again Monday night. Plus wind. We didn’t get above freezing from fairly early Sunday evening until just after noon on Tuesday, and then we reached only 32F. I am happy to report, though, that we have not run out of firewood, and our wood stove is doing a good job of keeping the house warm.

As much as I like heating with a wood stove, I have to admit that it’s a dirty business.

You may remember (but probably don’t) that I installed a duct with an in-line blower from the ceiling above the stove across the width of the house to a wall in our bedroom. Our heating/air conditioning guy doubted that it would work, but, hah! Even at below-freezing temperatures we can keep the living room around 72-73F, and the bedroom between 68F and 70F.

During the day the sun helps warm the bedroom, and the dogs.

The outlet is behind and to the left of the bedside table.

If you look carefully, and I would appreciate it if you wouldn’t, you can see that even now, a year and a half after we moved in, I do not have all the baseboards installed. My excuse is that I did a lot of door frames last year, cut a lot of firewood, and then spent a lot of the summer trying to get grass to grow in the front yard. Growing grass must be watched very closely.

But back to the heating blower. It is not too loud, as I had hoped, since it’s isolated in the attic. Unfortunately there is some sound from the air exiting the grill in the bedroom. We usually turn the blower off at night, but the last two nights we have left it on. If we turn the blower off, the bedroom cools to 66F or so.

Our stove has a very small firebox.  We chose this unit essentially for that reason, since I was afraid a larger stove would make it unbearably hot in the living room. Once it’s up and running, it’s able to keep the house at a reasonable, although not uniform, temperature. However, because the body of the stove is made from stone, it heats up significantly more slowly than a cast-iron or steel stove. That means it takes a while to go from lighting a fire to getting the living room warm. A full load of seasoned oak will burn down to glowing embers in about three hours. To keep the stove hot and the house warm I have to get up in the middle of the night to add more wood. The last two nights, I loaded wood twice because I left the stove draft open to keep a good, hot fire, and it burns more quickly that way.

I have heated with wood for a long time. When I moved to Huntsville, Al, back in 1986, I bought a small, cheap mobile home. My friend Tom in New Mexico gave me a simple, cast-iron box stove. I used a hunting knife to cut a hole in the roof and installed it in the living room. I used it so much that in the six years I lived there I didn’t have to have my propane tank refilled.

When I bought a house in 1992, there was a wood stove in the living room. In winter I set the thermostat at around 50 and heated with the stove. When I left for work I loaded up the stove, but by the time I got back home in the evening, the house was pretty cool. If I left for the weekend, it was 50F in the house when I got back home. The living room was huge, with a very high cathedral ceiling. It took quite a while to get a fire going and warm the room. I didn’t have any way to get the heat anywhere else in the house, so I heaped blankets on the bed and slept in a cold bedroom. None of that bothered me. I am pretty sure all of it would bother Leah, so we do not set the thermostat at 50 today.

It’s unquestionably more trouble to heat with wood than to just let the heating system work. There’s finding and cutting trees, splitting and stacking, constantly bringing wood to the house, and cleaning up all the mess in the living room. But I find it satisfying.

Happy New Year

Well, it’s 2018 now. I hope everyone has a better new year than the one we just finished. Rather than mull over what has happened — there will be a time for that — I thought I would just talk about bread pudding.

Bread pudding originated as a way to get rid of old, stale bread, so it’s considered a sort of pedestrian dish. But it’s one of my favorites. Maybe that says something about me. Anyway.

I lost the recipe I used the last time I made bread pudding, so I had to find a new one. I couldn’t find one that really appealed to me, so I kind of winged it. I did remember the first step: toast the bread. As I recall, that’s supposed to be better than simply letting it get stale because it drives out more moisture and allows the bread to soak up the custard without getting too soggy. So toast I did.

That’s a loaf of French bread allowed to get a little stale to make it easier to cut into cubes, then toasted for a little while under the broiler. Next I dumped a good bit of skim milk onto the bread and let it soak in. The recipe did not call for skim, but that’s what we have. I added a little evaporated milk to thicken it up. I like lots of raisins, and I added some chopped pecans that were not called for.

This is the second batch I made. The first batch seemed a little too soggy. There’s a happy medium somewhere between soggy and dry. The second batch was a little bit towards the dry end of that range. I think if I averaged the two batches it would have turned out just about right.

I made three separate sauces, regular, premium and mid-grade. The premium had about two ounces of bourbon in a cup of sauce. The regular had none, and the mid-grade had about an ounce.

I used a graphic code that I hoped would be self-explanatory. I find that the older I get, the more my humor gets like my father’s. It’s something he would have done.

Leah taste tested.

At first I thought the strong sauce was a little too strong, but after tasting all three I decided it was actually the best.

Here’s the finished bread pudding, tastefully garnished with half pecans.

I took these up to Chattanooga for Christmas dinner with my brother and his wife, and his two sons. I also got to meet my niece-in-law, my younger nephew’s new wife. My brother, who became an ordained Presbyterian minister after a career in science, performed the marriage ceremony.

I was the only one who ate any of the bread pudding, but I left some in case anyone wanted any later. And some of the strong sauce.

Christmas dinner was one of the high points of the past year, coming after some unfortunate family news just before Thanksgiving. I’m not quite ready to talk about that particular news. For the time being we’ll all just be happy with what we have now.