4-26-10

 So many have made such special offers of support, sent rounds of uplifting messages and get well cards.  It has been immensely helpful.  We are fortunate indeed.

 Status: 9.0/10.  I know it’s almost ludicrous to give myself such a rating especially with chemotherapy pouring into my veins for the last 12 hours, but I actually feel good right now.  Which of course demands the obvious question, “Then what the hell am I doing here?”  My laboratory values for general organ assessment (kidney, liver, that sort of thing) have come back into the normal range after getting knocked off-limits after the first 3 days of chemotherapy.  Two days of rest and having family here makes a lot of difference.  Interesting note – in my room is a Dell computer and a large 24” flat panel display.  The nurses enter all my vital signs, fluid input and output, access my lab values, track medications, and deal with all my other patient information right on the computer.  Gone, I guess, are days of a clipboard at the foot of the bed!

 Events: Today we started the next phase in the chemotherapy regimen early this AM, or as my attending physician says “the real stuff.”  The mainstay of treatment for my type of leukemia is cytosine arabinoside (SIGHT-oh-seen uh-RAB-uh-no-side), also called cytarabine or Ara-C.  I’ll receive it 24 hours a day over the next 3 days.  It’s highly toxic to cells, with the intent of doing the leukemic cells some serious harm (unfortunately, the rest of me is what the military refers to as collateral damage).  It’s distributed to all body fluids, and even comes out in tears, so I’ve already started receiving cortisone-like eye drops to lessen eye irritation. 

 Comments: Cytosine arabinoside works by disrupting the copies of DNA in a cell when it tries to divide and multiply.  Watson and Crick won the Nobel prize for discovering the chemical structure of DNA, that famous spiral-shaped ladder.  Each rung of the ladder is composed of a pairing of two of four molecules: adenine, thymine, guanine, and cytosine, simply referred to as A, T, G, and C.  The new Director of the NIH and former head of the Human Genome Project, Dr. Francis Collins, refers to DNA, “as made up of that simple 4-letter vocabulary.”

   It turns out that on each rung, A is always paired with T, and G with C.  So imagine painting the rungs of a very long ladder (half a rung at a time) using only 4 colors, say red, yellow, green and blue – and with the restriction that on each rung the red half is always paired with a green half, and blue with yellow.  If you looked down the ladder you’d see a monotonous series of rungs, red-green, yellow-blue, green-red, yellow-blue, and on and on.  Monotonous, yes, but that unique pattern is the “genetic code” that makes you, you. 

   Now, say you used a chainsaw to cut the ladder right down the middle, leaving two fairly useless, yet nicely-colored, half-ladders with their half-rungs sticking out.  But you could fix things by going to Home Depot and buying two long pieces of wood (the same length as the ladder) and a bunch of rungs.

   Cut the rungs in half and glue them onto the long pieces of wood making two unpainted half ladders.  Place them next to, and glue them to, the previously painted half-ladders.  Paint all the blank half rungs, making sure to follow the rules of red to green, blue to yellow.   Voilà, you’ve ended up with two ladders that look exactly like the original (if you’re worried one is the opposite of the other, just flip it over – they’re identical twins).  You could play the chainsaw game over and over, and as long as you had access to a Home Depot and a credit card you could make as many copies of that first ladder as you wished.

   And that’s the same game DNA plays when it wants to make a copy of itself, but with A, T, C, and G – unzipping its spiral length into two half-ladders and attaching those 4 letters, making two copies of itself.  [Note: mutations occur when you paint a wrong color, misalign the two half- ladders, or mistakenly add or delete a rung].      

   But what if instead of the real C (cytosine) you provided a supply of a wrong-sized lookalike molecule (cytosine arabinoside) just as though you had bought wrong-sized rungs at Lowes.  You’d end up with a faulty ladder (bad DNA).  And in this case, a dead cell, if it tried to divide and copy itself.

   Leukemic cells are dividing rapidly, and most other body cells are dividing much more slowly, so the leukemic cells are at special risk for this kind of attack.  So you’d be attempting to use a laser-guided missile to knock out a target while hopefully cutting down on collateral damage. 

 So that’s the plan for this next phase, with the hospital staff trying to help me duck and cover from the missile strikes.  We’ll give you a daily bomb damage assessment and how the troops are holding up.  Root for the good guys.

 Love,

 -B

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22 Responses to “”

  1. Judi Golding-Baker Says:

    HI B –
    So now’s the “real stuff”… well, I’m rooting for all of the those good guys to take up arms and fight like hell!

    I love you Bruce…hope you’re able to get a little rest when you can.

    Hug and kiss,
    Judi

  2. Jill Stewart Says:

    I’m addicted to your explanations. It’s guilty addiction, though, considering what you are experiencing to provide. This stuff is CME-worthy. 🙂

    Jill O

  3. Laurie Samuels Says:

    Bruce,

    Sounds as if you are getting down to business…. Harry and I hope you have a good night, hope you can get some rest. Sleep is the best meditation. I’m pulling for the good guys, too! Hoping tomorrow is another 9.0 or better!

  4. Judy and Larry Says:

    Bruce
    Love, love, love your analogies and descriptions. So glad to hear you are feeling good today. Hope it continues. We are rooting for you and the good guys. We continue to keep you in our thoughts and prayers.
    Hope you like the candy…. we thought you could use a taste of home.
    Love, Judy and Larry

  5. Eileen Breslin Says:

    Dear Bruce,
    We are routing for the good guys….hope the nurses are tending more to you and not the 24 inch computer screen!! Nothing like the family to shore you up for the upcoming battle. We are thinking of you daily and sending our prayers and positive thoughts…..love Eileen and Bill

  6. Donna Hill Howes Says:

    Let the good guys RULE!! Bruce, I could have used a few professors like you when in Nursing and Grad school….you make even the mundane interesting!! Now I’m going to insist that you turn this series of blogs into a book….need a good publisher? BINGO…think that can be arranged.
    Hey, I’m stoked because I’ll be in D.C. at the end of next week….will call to see if you’re up for a 15 min visit…don’t want to impose, just couldn’t imagine being so close and now swingin by to see my favorite professor!
    Fight on good soldier! Love, Donna

  7. wendy Says:

    B-your current chemo reminds me of training for a marathon.. as you well know….you do all this practice to prepare for the “real thing” but you never have to actually do a practice run of 26 miles until the actual real race.. up ’til then you are getting your body ready and saving the best for last… the real race. So this is the race..and you’ve done great so far.. so here’s to being the winner of the RACE!! Hang in there- The finish line is within sight… love wendy

  8. Johnny & Lake Says:

    What a fabulous soldier you are — part of ‘special forces’ clearly – though at the mo your description made me think of your common ground with, of all people, the great boxing genuis, Ali, with his ‘fly like a butterfly, sting like a bee’. You’re in for the whole 15 rounds, though a TKO by your good self to those crap horrid cells could happen at any time! We love you and love you and love you some more xxx Johnny and Lake

  9. Johnny & Lake Says:

    What a fabulous soldier you are — part of ‘special forces’ clearly – though at the mo your description made me think of your common ground with, of all people, the great boxing genius, Ali, with his ‘fly like a butterfly, sting like a bee’. You’re in for the whole 15 rounds, though a TKO by your good self to those crap horrid cells could happen at any time! We love you and love you and love you some more xxx Johnny and Lake

  10. Meredith Says:

    Bruce,
    I admire your humor and strength in this time. I also love reading your posts and your wonderful descriptions.

    I’ll say special prayers during this tough three day missile crisis in your body.

  11. Susan Hayes Says:

    Bruce –
    So sorry to hear about your illness, but it is so like you to try to explain the science of what is going on in your body to us ignoramuses. (I really don’t know how to spell that). Keep fighting the good fight. My thoughts and prayers are with you and hope to work together again soon when you are well.

    Much love,
    Susan

  12. Melissa Rose Says:

    Hi Bruce
    Char Woods passed on the news of your illness. I’m so sorry to hear about another person going through cancer treatment. Just wanted you to know that the Bentons class of 90 are sending you good wishes. Speedy healing man. Best,
    Melissa Rose

  13. George Lundberg Says:

    Hey Bruce,
    Bill Silberg just told me about your situation. Yours is one of the best ongoing medical patient blogs I have seen. You have always been the consummate multimedia medical teacher. I guess today is day 9 on your initial 10 day chemomarathon. “No hill for a climber”. Hang in there.
    george lundberg

  14. Sheryl Stolberg Says:

    Hi Bruce. Just checking in. I’m rooting for the good guys.
    Inside joke: Have you traced the genetics of male pattern baldness yet?
    🙂
    Sheryl

  15. Bill Israel Says:

    I’m pulling on my helmet and flak jacket for you, Bruce, and big time rooting for the good guys — meaning you! We’re thinking of you, and wishing you well in this next, important phase of your treatment. Best wishes, Bill and EIleen

  16. Wayne Pines Says:

    Bruce:
    Carol and I are thinking about you and looking at your blog every day, just to be reassured that you’re making medical progress and maintaining your spirits.
    Keep up your humor and spirits!!
    Carol and Wayne

  17. Joel Steinberg Says:

    Dear Bruce and Lisa: My heart aches as I read your blog. This is genuine “sledgehammer” chemotherapy. It makes what Margaret is going through seem like child’s play. Eight years ago I underwent 6 months of Interferon-Riboviren treatment for Hepatitis C (Yes, doctors can catch diseases from their patients). It was not pleasant, but I never quite needed transfusions, nupogen, epogen, etc. When the infection was eradicated, I took a fresh look at life and decided I would retire early and just enjoy things, a decision I have not regretted. Margaret and I are really hoping that you can be cured of the leukemia and will be able to enjoy life once more.

  18. Frank Golding Says:

    that’s it. i’m giving you my DNA. tell me where to send it.

    rooting for the good guys, and reading often, much love bruce, f

  19. Judie Davidson Says:

    Hi Bruce,
    Just

  20. Judie Davidson Says:

    Just started reading your blog today and with bittersweet feelings, I enjoyed reading it. Please know that I think of you many times a day. Also, give my love to Lisa and Ethan and Rachel. I have gotten much mileage out of your story about Ethan celebrating MLK day and realizing that his soccer friend was black. I will keep reading as long as you keep posting.
    Judie

  21. Carolyn Hyde Says:

    Patrick and I think about you every day, sending good karma your way. Your unique personality and wit continues to captivate as you chronicle your journey. We just know that you’ll emerge triumphant and beat this disease into remission.Madeleine reads from the Torah this Saturday; and Patrick, my mother and I will all say an extra prayer for your complete and speedy recovery.
    Much Love and Strengh Coming Your Way,
    Carolyn and Patrick

  22. Barbara Bolsen Says:

    Hey Bruce — I’ve just read your entire blog (came to the party late). I’m glad you are weathering the treatment well so far, and so glad for all the support surrounding you. The blog’s amazing — you are indeed an unregenerate teacher. I especially appreciate your observations on what it’s like to be on the other side. Take care, and I’ll be following your progress closely. Affectionately, Barb

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