5-18-11 Wednesday  + 6 ¾ months

Status:  Doing better after a tiring last week, but lab results at Hopkins pointed out that no good deed goes unpunished.

  Hematology results were fine, but my blood sugar was up at 589 (normal 70-100), a result of the prednisone I’m taking (corticosteroids block insulin’s ability to get glucose into cells).  I was lethargic, had blurred vision, drinking and urinating a lot, and getting up in the middle of the night to eat.  

 When blood sugar gets over 200 or so, sugar spills out in the urine and carries water with it (the kidney knows not to pee out syrup).  So you get thirsty and drink more water, and these up and down changes make the body’s cell water content increase and decrease, including the fluid in eye’s lenses, which causes them to expand and contract, resulting in blurred vision.

My mental acuity was somewhat diminished – when I play chess against my computer, the computer wins most of the time (I occasionally can beat it in the end game of the Sicilian opening), but over the last week I have almost always lost early on from what chess players would call blunders.

My docs have put me on an oral diabetic medicine that causes the pancreas to put out more insulin, and my fasting blood sugar dropped to 150 in a day (I played chess to a stalemate).  Now I know what being diabetic feels like – I’m counting calories and carbs, sticking my finger twice a day for blood sugars.  This whack-a-mole will only last until I’m off prednisone in about 6-8 weeks or so, and I can get back to my milkshakes!  

Events: Along with the lab reports this week at Hopkins was my scheduled lumbar puncture with chemotherapy injected into the spinal fluid.  The procedure went well, but you do have stay lying flat for 2 hours afterwards.  Only 3 more to go, scheduled 1 month apart. Next lab check in 2 weeks.

Comments: The chemotherapy introduced into my spinal fluid is meant to kill any leukemic cells that may be hiding there.  We’re using methotrexate, an anti-metabolite, which looks chemically like folic acid (folate) a necessary molecule for DNA production.  Fast growing cells take in the chemical counterfeit and damage themselves.  Of course, folate is essential for embryonic growth, too.

  I was fortunate enough at JAMA to shepherd through the breakthrough study by CDC that showed that spina bifida was caused by a low level of folate in pregnant women’s diet.  Since then cereals and other foods have been fortified with folate.  But the spinal development happens in just the first weeks after conception (when women don’t even know they’re pregnant), so any women of child-bearing age should be taking folate supplements.

  I have had so many conditions resulting from my original disease and its treatment that I have become much more empathetic to patients with those ailments.  If I had learned these lessons at a younger age I’m certain I would have been a better doctor. [I do have to confess that as an intern I took many of the meds my patients were taking to see what the side effects were like (Lasix and urination, nitroglycerin and headaches, etc.]

 Looking to keep my carbs down, calories up, and beating my computer (my brothers are sure to comment on how they beat me in chess).

 Love,

-Bruce

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17 Responses to “”

  1. Judy and Lewis Lefkowitz Says:

    Enjoy and thrive on the fat-and-proten diet. And when the predisone stops back to the shakes and cakes.

  2. Bill Israel Says:

    Play on, Bruce! Loved chess as the indicator for your acuity. I hope to learn to hurdle over obstacles the way you have, over and over. Good work, and know we’re thinking about you! Bill

  3. Peggie Neill Says:

    Bruce,
    Keep the faith. We are – in you.
    Love to you and family –
    Peggie

  4. winnie Says:

    hi
    you have more stamina than most people!! Hurrah for you!!
    all the best
    winnie

  5. Barbara McKee Says:

    That was a great deal of information but so thrilled about all of the good news that preceded this report. Just another “bump” or annoyance in your remarkable recovery. You deserve those milkshakes so hope you can get them back soon.

  6. Carolyn Hyde Says:

    Bruce,
    A bit of a roller-coaster ride for sure, but looking forward to your cheering with glee on your new found good health soon. Patrick and I send bear hugs your way.
    Carolyn Hyde

  7. mike magee Says:

    Bruce-

    Just caught up on “your travels” over the past few weeks. Quite a journey! Was pleased the pneumonia was non-specific and that the steroids (inspite of the diabetes) is working. Your ability to look forward has always been one of your remarkable traits – never more visible than in your incredible face-off with this challenge. Happy (belated) Passover and God bless you!

    Mike

  8. Henry -the youngest brother Says:

    The key to beating Bruce in chess is to survive the opening (of which he knows several variations cold) and muddle through the middle game. Then, in the end game, it gets down to just a few pieces, you can beat him when he gets frustrated because “you are not making the ‘right moves'” according to him.
    I learned by watching him and Terry play, and although all agreed Bruce was much smarter than everyone else, Terry always seemed to win. Hmmm?
    You’ll notice that, although I read Bruce’s blog faithfully, I generally do not comment. I normally just send my thoughts directly to him via email.
    I would, however, like to take this opportunity to express how proud I am of Bruce (and Lisa) for waging this epic battle with courage, fortitude and a sense of humor that everyone else benefits from.
    Bruce, I’ve always looked up to you and will continue to do so (even though I am definitely the tallest in the family!)
    Much love and appreciation…Hank

  9. Bill Schaffner Says:

    Bruce:

    Just a quick note to let you and Lisa know how thrilled we are about your recent lab results. The monster has been slain!

    Am empathetic re your “many conditions resulting from my original disease and its treatment”. As to the latter, didn’t we used to refer to them as “diseases of medical progress”? That was back in the ‘60s and ‘70s, now we call them *#!x*. Seriously, an interesting exercise would be for you to revisit your saga and make a list of all these medical complications of your treatments. I continue to see this as grist for your post-illness writings.

    You had me sit up straight when you said that as an intern you had sampled your patients’ meds to see what the side effects were like. You clearly were more adventurous than I. Do you know of anyone else who did this? I’ve not heard of this before. Perhaps another article in the making?

    Cheer,

    Bill

  10. Chaya Says:

    sO SORRY YOU HAVE GO THRU A BIT OF MY DISEASE AND YES YOU HAVE TO LEAVE THE STRIP IN GET YOUR RESULTS, TAKING IT OUT JUST TURNS THE METER OFF, WISH MY DIABETES WOULD GO AWAY WHEN YOURS WILL.

    SO MUCH LOVE ON THE WAY TO YOU .

  11. Penelope Douglas Says:

    Hey Bruce, I suppose as with most everything else in life recovering from acute leukemia and a subsequent bone marrow transplant is a journey. And we here at ITV are pulling for you (uhh cheering for you , i wish we could help pull you) every step of the way.
    I really do love the positive attitude you convey in your blog. You give others who are facing “challenges” in life the courage to continue the battle. Keep up the good work!

  12. Tom Linden Says:

    Every time I read one of your posts, Bruce, I learn something new about medicine, about life and about you. Thanks for sharing. You’re in my thoughts.

  13. wendy Says:

    you have learned enough. Time to return to your healthy life. We pray for that sooner than later.

  14. wendy Says:

    A side note to Hank’s and Bruce’s chess story. The family game that shows more of Bruce’s fortitude, in my belief, is RISK or Monopoly. Needless to say that Bruce won those all the time. His “winning attitude” showed up from the beginning and remains one of his biggest strengths.
    And as we have seen, what doesn’t kill you, does make you stronger. Bruce, I admire your strength, your fortitude, and more importantly what you have learned over the years and most certainly through this illness and recovery…your true compassion

  15. Ashby Says:

    Bruce,
    If mental acuity is measured on the basis of success against a computer playing chess, then I may need to be committed. I thought a “Sicilian opening” was the first few scenes in Godfather III.

  16. Gail Lehmann Says:

    Bruce, we have been away and I am catching up on your blog. About diabetes, Mark was diagnosed a year ago and since then we have met with a nutritionist twice and he is managing it with diet and exercise. If you LOVE pasta (and who doesn’t), get DREAMFIELDS which is recommended by the diabetes website and is low in carbs (5 digestable per serving} rather than 42. Not sure how it works, but worth a try. Mark went from diabetes to pre-diabetes and we are working hard to keep him at that level.
    Sorry we won’t see you this weekend, but look forward to December.
    Love,
    Gail

  17. jon Says:

    good post

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