I had another MRI on Tuesday of this week, then had an appointment with my oncologist on Thursday and my radiation oncologist on Friday. Long story short: "...Apparent progression of disease within the left parietal lobe...." Disappointing news, but not totally unexpected. I've noticed fairly dramatic worsening of my gait abnormalities in the past couple of weeks, probably brought on by brain swelling as a result of tumor growth. So now I'm back on the corticosteroid dexamethasone to hopefully reduce the swelling. In addition I will most likely begin an IV chemotherapy drug bevacizumab (Avastin) within the next couple of weeks. Avastin is approved by the FDA for treatment of glioblastoma as a single agent for patients with progressive disease following prior therapy. It is administered by intravenous infusion every two weeks. Treatment is usually continued until disease progression or unacceptable toxicity. Given the nature of the disease, Avastin was generally well tolerated in two small clinical trials. My prior therapy was radiation therapy and the oral agent temozolomide (Temodar). I am hopeful that I will get some benefit from the Avastin. As Marge says, we have to play with the cards we're dealt.
We also went to Ed Caldwell's funeral on Wednesday. Ed was a wonderful and gentle man who became the first African-American graduate of the Oregon State University College of Pharmacy. He finished his pharmacy career at Providence St. Vincent Medical Center's outpatient pharmacy. I got to know Ed when I was an inpatient pharmacist there at the same time. Coincidentally I worked with Ed's wife Donna at Kaiser Permanente for several years after I left PSVMC and before Donna retired. Great people, and a wonderful couple. Ed will be missed by his many friends. If you look up the word "gentleman" in the dictionary, you will find a picture of Ed Caldwell.
Pete and Tracy and their girls are visting with Andy and Ali and their boys this weekend. The circus is on their agenda for tomorrow. I can imagine it would be a circus without the circus with the four little kids. Lucy happened to be running by when I was on the phone with Pete after they arrived in Redmond this evening. Pete asked her if she wanted to say hello to Grammy and Papa. She replied very politely, "No thank you." (Too busy to talk.)
My old Kaiser work group is having an end-of-summer get-together on Sunday. We are looking forward to seeing the old gang. And finally, we are getting together with Jim and Susan Sanger, who now live in St. Louis. I worked for Jim at Good Samaritan Hospital before I went to PSVMC. Small pharmacy world in Portland.
P.S. We have a new email address: nomarmuilenburg@frontier.com
Friday, September 17, 2010
Wednesday, September 1, 2010
Are you ready for some football?
College football gets started tomorrow, Thursday, September 2. No. 14-ranked USC, unable to find an opponent on the mainland, will travel to Hawaii to play the Warriors. Prior to the year 2000, the University of Hawaii's men's teams were all referred to as the Rainbow Warriors, complemented by an athletics logo featuring a rainbow. However, in a controversial marketing strategy over which many at the University and throughout Hawaii have misgivings, the school changed its athletics logo to a stylized "H" and allowed each team to pick its own team name. This has led to the current situation, where the basketball, swimming and diving, and tennis teams have retained the team name of "Rainbow Warriors"; the baseball team adopted the name "Rainbows"; and the football, golf, and volleyball teams have adopted the name "Warriors". But I digress....
Also on Thursday the unranked Golden Gophers of Minnesota travel to play the Blue Raiders of powerhouse Middle Tennessee State University of the Sun Belt Conference. (The Blue Raiders of MTSU, located in Murfreesboro, TN, are not to be confused with the Blue Smurfs of Boise State.) Minnesota is picked to be the 11th (last) team in the Big Ten Conference. This is possible only because the conference kept the name "Big Ten" when Penn State was added a few years ago to make an 11-team conference. On Saturday No. 24 Oregon State takes on No. 6 TCU in Dallas, No. 11 Oregon plays unranked New Mexico, Washington plays at BYU, and Washington State plays at Oklahoma State.
Which brings us back to poor ol' USC. A USC football player was bragging to a group of coeds that he finished a jigsaw puzzle in only three months. One girl said, "Three months? You're proud of that?" The Trojan replied, "Yep; on the box it said 4-6 years." [Shamelessly lifted from "The Edge" column in The Oregonian.]
As a public service to the 2 or 3 individuals reading this who may be interested, I've tried to sort out the college athletic conference realignment, which was no easy task. The eleven-member Big Ten conference will add Nebraska to become the Bigger Ten or the New Big Twelve Conference. The Big 12 Conference will lose Nebraska to the Big 10 and Colorado to the Pac-10 to become the New Big 10 or the Little Big 12. The Pac-10 Conference will add Colorado and Utah to become, presumably, the Pac-12. Now here is where it gets interesting; pay attention. The Western Athletic Conference (WAC) will lose Boise State, Fresno State, and Nevada, all of which will join the Mountain West Conference. But the Mountain West will lose Utah to the Pac-10/Pac-12 and will also lose BYU. BYU will play an independent schedule in football but will join the West Coast Conference for basketball and other sports. The West Coast Conference will consist of seven Catholic universities or colleges (Portland, San Francisco, Santa Clara, Gonzaga, Saint Mary's, San Diego, Loyola Marymount), Pepperdine (Church of Christ), and BYU (Mormon). But not for football. So now you know....
Also on Thursday the unranked Golden Gophers of Minnesota travel to play the Blue Raiders of powerhouse Middle Tennessee State University of the Sun Belt Conference. (The Blue Raiders of MTSU, located in Murfreesboro, TN, are not to be confused with the Blue Smurfs of Boise State.) Minnesota is picked to be the 11th (last) team in the Big Ten Conference. This is possible only because the conference kept the name "Big Ten" when Penn State was added a few years ago to make an 11-team conference. On Saturday No. 24 Oregon State takes on No. 6 TCU in Dallas, No. 11 Oregon plays unranked New Mexico, Washington plays at BYU, and Washington State plays at Oklahoma State.
Which brings us back to poor ol' USC. A USC football player was bragging to a group of coeds that he finished a jigsaw puzzle in only three months. One girl said, "Three months? You're proud of that?" The Trojan replied, "Yep; on the box it said 4-6 years." [Shamelessly lifted from "The Edge" column in The Oregonian.]
As a public service to the 2 or 3 individuals reading this who may be interested, I've tried to sort out the college athletic conference realignment, which was no easy task. The eleven-member Big Ten conference will add Nebraska to become the Bigger Ten or the New Big Twelve Conference. The Big 12 Conference will lose Nebraska to the Big 10 and Colorado to the Pac-10 to become the New Big 10 or the Little Big 12. The Pac-10 Conference will add Colorado and Utah to become, presumably, the Pac-12. Now here is where it gets interesting; pay attention. The Western Athletic Conference (WAC) will lose Boise State, Fresno State, and Nevada, all of which will join the Mountain West Conference. But the Mountain West will lose Utah to the Pac-10/Pac-12 and will also lose BYU. BYU will play an independent schedule in football but will join the West Coast Conference for basketball and other sports. The West Coast Conference will consist of seven Catholic universities or colleges (Portland, San Francisco, Santa Clara, Gonzaga, Saint Mary's, San Diego, Loyola Marymount), Pepperdine (Church of Christ), and BYU (Mormon). But not for football. So now you know....
Tuesday, August 24, 2010
End-of-life care
Interesting reading, if you are interested in the topic, that is. A long article about re-thinking end-of-life treatment by Atul Gawande in the August 2 issue of The New Yorker. Gawande is a surgeon at Brigham and Women's Hospital in Boston and an associate professor at Harvard Medical School and the Harvard School of Public Health. He has written several best-selling books. Here is a statistic to ponder: According to Gawande, 25% of all Medicare spending is for the 5% of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.
This article was closely followed by the publication of a study in the August 19 edition of The New England Journal of Medicine. Also included is a related news article and some editorials generated by the study.
1. Gawande A. Letting go. The New Yorker 2010 Aug 2; p. 36-49.
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande
2. Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-42.
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678
3. Kelley AS, Meier DE. Palliative care: a shifting paradigm [editorial]. N Engl J Med 2010;363:781-2.
http://www.nejm.org/doi/pdf/10.1056/NEJMe1004139
4. McNeil DG Jr. Palliative care extends life, study finds. The New York Times 2010 Aug 18.
http://www.nytimes.com/2010/08/19/health/19care.html?ref=donald_g_jr_mcneil
5. The Oregonian Editorial Board. Rx: a dose of old-fashioned comfort [editorial]. The Oregonian 2010 Aug 19.
http://www.oregonlive.com/opinion/index.ssf/2010/08/rx_a_dose_of_old-fashioned_com.html
This article was closely followed by the publication of a study in the August 19 edition of The New England Journal of Medicine. Also included is a related news article and some editorials generated by the study.
1. Gawande A. Letting go. The New Yorker 2010 Aug 2; p. 36-49.
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande
2. Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-42.
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678
3. Kelley AS, Meier DE. Palliative care: a shifting paradigm [editorial]. N Engl J Med 2010;363:781-2.
http://www.nejm.org/doi/pdf/10.1056/NEJMe1004139
4. McNeil DG Jr. Palliative care extends life, study finds. The New York Times 2010 Aug 18.
http://www.nytimes.com/2010/08/19/health/19care.html?ref=donald_g_jr_mcneil
5. The Oregonian Editorial Board. Rx: a dose of old-fashioned comfort [editorial]. The Oregonian 2010 Aug 19.
http://www.oregonlive.com/opinion/index.ssf/2010/08/rx_a_dose_of_old-fashioned_com.html
Monday, August 23, 2010
Movie review: "Inception"
You may have noticed the lack of recent blogging. Nothing much new about me. I finished my last course of temozolomide (oral chemotherapy) and now await another MRI on September 2, the results of which will hopefully be more definitive than those in the past. Was it pseudoprogression (radiation debris) or is it actual progression? Past MRIs were unable to distinguish between the two. If it was radiation debris, that should now have disappeared.
Since I have no news, I thought I'd compare my review with two published reviews of the movie "Inception," which to date has $261.8 million in ticket sales at movie theaters.
Shawn Levy, The Oregonian: Grade A. A deeply dazzling and immense film about a team of mind-explorers trying to implant an idea in a subject's heavily guarded subconscious. Filled with logical puzzles, jaw-dropping action and audacious visuals, it's the brainchild of Christopher Nolan's "Memento" and one of his special-effects movies. Superb....
“Memento” on the scale of “The Dark Knight”: Dense, operatic, thrilling, puzzling, vexing and utterly, utterly brilliant. A man adept at stealing secrets from people while they dream must reverse his process and plant an idea in someone’s head -- and risk his own sanity in the process. It’s a metaphor for moviemaking, of course, with its dreams-within-dreams-within-dreams (it actually goes much deeper....). But it’s also a mournful and nervy depiction of a man driven by loss and guilt and fear. Leonardo DiCaprio seems still in “Shutter Island” mode, which isn’t a bad thing. But a wonderful supporting cast gives it brightness and lift. And writer-director Christopher Nolan’s visual ideas, pacing and audacity mesmerize.
David Denby, The New Yorker:
Christopher Nolan, the British-born director of “Memento” and of the two most recent Batman movies, appears to believe that if he can do certain things in cinema—especially very complicated things—then he has to do them. But why? To what end? His new movie, “Inception,” is an astonishment, an engineering feat, and, finally, a folly. Nolan has devoted his extraordinary talents not to some weighty, epic theme or terrific comic idea but to a science-fiction thriller that exploits dreams as a vehicle for doubling and redoubling action sequences. He has been contemplating the movie for ten years, and as movie technology changed he must have realized that he could do more and more complex things. He wound up overcooking the idea. Nolan gives us dreams within dreams (people dream that they’re dreaming); he also stages action within different levels of dreaming—deep, deeper, and deepest, with matching physical movements played out at each level—all of it cut together with trombone-heavy music by Hans Zimmer, which pounds us into near-deafness, if not quite submission. Now and then, you may discover that the effort to keep up with the multilevel tumult kills your pleasure in the movie. “Inception” is a stunning-looking film that gets lost in fabulous intricacies, a movie devoted to its own workings and to little else....
Summarizing the movie makes it sound saner than it is. For long stretches, you’re not sure whether you’re in dream or reality, which isn’t nearly as much fun as Nolan must have imagined it to be. Bizarre oddities, which complicate the puzzle but are meaningless in themselves, flash by in an instant. The actors, trying to suggest familiarity with the task of dream invasion, spin off gibberish in the most casual way. Parodies, I assume, will follow on YouTube. And the theologians of pop culture, taking a break from “The Matrix,” will analyze the over-articulate structure of “Inception” for mighty significances....
I would like to plant in Christopher Nolan’s head the thought that he might consider working more simply next time. His way of dodging powerful emotion is beginning to look like a grand-scale version of a puzzle-maker’s obsession with mazes and tropes.
Norm's review:
There are only two (small) things wrong with this movie:
(1) I didn't know what the hell was happening throughout the movie. It might not have helped that I fell asleep for a period of time during the movie, but I put the blame for that on Christopher Nolan.
(2) The movie went on FOR-EVVVV-ERRRR (148 excruciating, painfully slow minutes, to be exact).
So there you go. If you are one of the few who haven't yet seen this movie, you can believe Shawn Levy, or you can believe David Denby. Personally, I side with David Denby. (You can tell I don't get out much.)
Since I have no news, I thought I'd compare my review with two published reviews of the movie "Inception," which to date has $261.8 million in ticket sales at movie theaters.
Shawn Levy, The Oregonian: Grade A. A deeply dazzling and immense film about a team of mind-explorers trying to implant an idea in a subject's heavily guarded subconscious. Filled with logical puzzles, jaw-dropping action and audacious visuals, it's the brainchild of Christopher Nolan's "Memento" and one of his special-effects movies. Superb....
“Memento” on the scale of “The Dark Knight”: Dense, operatic, thrilling, puzzling, vexing and utterly, utterly brilliant. A man adept at stealing secrets from people while they dream must reverse his process and plant an idea in someone’s head -- and risk his own sanity in the process. It’s a metaphor for moviemaking, of course, with its dreams-within-dreams-within-dreams (it actually goes much deeper....). But it’s also a mournful and nervy depiction of a man driven by loss and guilt and fear. Leonardo DiCaprio seems still in “Shutter Island” mode, which isn’t a bad thing. But a wonderful supporting cast gives it brightness and lift. And writer-director Christopher Nolan’s visual ideas, pacing and audacity mesmerize.
David Denby, The New Yorker:
Christopher Nolan, the British-born director of “Memento” and of the two most recent Batman movies, appears to believe that if he can do certain things in cinema—especially very complicated things—then he has to do them. But why? To what end? His new movie, “Inception,” is an astonishment, an engineering feat, and, finally, a folly. Nolan has devoted his extraordinary talents not to some weighty, epic theme or terrific comic idea but to a science-fiction thriller that exploits dreams as a vehicle for doubling and redoubling action sequences. He has been contemplating the movie for ten years, and as movie technology changed he must have realized that he could do more and more complex things. He wound up overcooking the idea. Nolan gives us dreams within dreams (people dream that they’re dreaming); he also stages action within different levels of dreaming—deep, deeper, and deepest, with matching physical movements played out at each level—all of it cut together with trombone-heavy music by Hans Zimmer, which pounds us into near-deafness, if not quite submission. Now and then, you may discover that the effort to keep up with the multilevel tumult kills your pleasure in the movie. “Inception” is a stunning-looking film that gets lost in fabulous intricacies, a movie devoted to its own workings and to little else....
Summarizing the movie makes it sound saner than it is. For long stretches, you’re not sure whether you’re in dream or reality, which isn’t nearly as much fun as Nolan must have imagined it to be. Bizarre oddities, which complicate the puzzle but are meaningless in themselves, flash by in an instant. The actors, trying to suggest familiarity with the task of dream invasion, spin off gibberish in the most casual way. Parodies, I assume, will follow on YouTube. And the theologians of pop culture, taking a break from “The Matrix,” will analyze the over-articulate structure of “Inception” for mighty significances....
I would like to plant in Christopher Nolan’s head the thought that he might consider working more simply next time. His way of dodging powerful emotion is beginning to look like a grand-scale version of a puzzle-maker’s obsession with mazes and tropes.
Norm's review:
There are only two (small) things wrong with this movie:
(1) I didn't know what the hell was happening throughout the movie. It might not have helped that I fell asleep for a period of time during the movie, but I put the blame for that on Christopher Nolan.
(2) The movie went on FOR-EVVVV-ERRRR (148 excruciating, painfully slow minutes, to be exact).
So there you go. If you are one of the few who haven't yet seen this movie, you can believe Shawn Levy, or you can believe David Denby. Personally, I side with David Denby. (You can tell I don't get out much.)
Monday, July 26, 2010
Friday, July 2, 2010
Repeat MRI
I had a second post-radiation therapy MRI on June 23, and met with my radiation oncologist a week later to discuss the results. It wasn't the best possible report nor the worst possible report. Something shows up on the scan, but short of doing a brain biopsy, which is not recommended, only time will tell what is going on. Could be "pseudo-progression" (a.k.a. radiation debris), which would be a good thing, because over time that should disappear. Could also be tumor progression, which would not be a good thing. So the plan is to stay the course, continue on the temozolomide, and repeat the MRI, again, in two months.
I'm feeling about the same, no pain, still able to walk Larue twice a day. But the neuropathy is getting worse, affecting almost my whole right side (hand, arm, leg, foot). But, one has to learn to live with it. When I'm out I use a cane, but I use a walker when walking the dog.
We hired a lawn maintenance service to take care of the yard. I just can't handle the mowing anymore. Rain yesterday and today; summer, as usual, should arrive on July 5.
I'm feeling about the same, no pain, still able to walk Larue twice a day. But the neuropathy is getting worse, affecting almost my whole right side (hand, arm, leg, foot). But, one has to learn to live with it. When I'm out I use a cane, but I use a walker when walking the dog.
We hired a lawn maintenance service to take care of the yard. I just can't handle the mowing anymore. Rain yesterday and today; summer, as usual, should arrive on July 5.
Dodgers Bean Town Road Trip
Pete, Andy, and I went on a baseball-themed trip to Boston for a three-game inter-league series between the LA Dodgers and the Boston Red Sox, June 18-20. I found the trip on dodgers.com, and we were among 150 Dodger fans on the tour. (Pete is not a Dodger fan, but he was kind enough to go along for my sake.) I flew to Boston direct from Portland; Andy flew from Redmond, and Pete flew from Eugene. We stayed at the Hilton Boston Back Bay Hotel, where the three of us shared a room with two queen beds. I got to sleep in one of the beds by myself, and Pete and Andy had to share the other bed, which they didn't seem to mind.
The package deal included game tickets to all three games, hotel room, polo shirts, "Mannywood" T-shirts, Fenway Park tour, and exclusive Dodgers brunch with team personnel. Team personnel included former Dodger manager and baseball icon/ambassador Tommy Lasorda, Dodger broadcaster Steve Lyons, and Dodger back-up catcher A.J. Ellis. Tommy is a real raconteur who could tell stories till the cows come home. Steve Lyons went to Marist High School in Eugene for two years, to Beaverton High for his senior year, and then on to Oregon State. Marist is where Pete and Tracy work, and Andy of course went to OSU, so lots of coincidences. The brunch was a highlight of the trip. The Sunday game was on ESPN, and Andy got his mug on camera for a brief time around the fourth inning.
Also among the photos that Andy took and Ali posted was one of the three of us with Ken Scheublin, who was in the Peace Corps with us and lived in the same town as Marge. Ken and his wife Meta live in Cambridge. We met in a bar for drinks before one of the games.
Fenway Park is 98 years old and does not have the ADA seal of approval, to say the least. I struggled a bit to get to my seat with no hand rails, but made it without falling down. We mostly went from hotel to Fenway and back by pedi-cab which could accommodate all three of us. We had the same seats for all three games, so we got to know the folks sitting around us, some nice people. It was an almost total sports weekend, with baseball, World Cup soccer, game 7 of the Lakers-Celtics NBA finals, and U.S. Open golf, where my friend Mark Nealy volunteered at Pebble Beach. Pete stayed an extra day and spent it with some friends who studied together for a semester in Spain, all of whom live on the East Coast.
It was a real treat for me that I got to spend Father's day with the boys. We are proud that they are such good fathers to their children. The only downside to the trip is that the Dodgers got swept by the Red Sox, which in the big picture was no big deal.
The package deal included game tickets to all three games, hotel room, polo shirts, "Mannywood" T-shirts, Fenway Park tour, and exclusive Dodgers brunch with team personnel. Team personnel included former Dodger manager and baseball icon/ambassador Tommy Lasorda, Dodger broadcaster Steve Lyons, and Dodger back-up catcher A.J. Ellis. Tommy is a real raconteur who could tell stories till the cows come home. Steve Lyons went to Marist High School in Eugene for two years, to Beaverton High for his senior year, and then on to Oregon State. Marist is where Pete and Tracy work, and Andy of course went to OSU, so lots of coincidences. The brunch was a highlight of the trip. The Sunday game was on ESPN, and Andy got his mug on camera for a brief time around the fourth inning.
Also among the photos that Andy took and Ali posted was one of the three of us with Ken Scheublin, who was in the Peace Corps with us and lived in the same town as Marge. Ken and his wife Meta live in Cambridge. We met in a bar for drinks before one of the games.
Fenway Park is 98 years old and does not have the ADA seal of approval, to say the least. I struggled a bit to get to my seat with no hand rails, but made it without falling down. We mostly went from hotel to Fenway and back by pedi-cab which could accommodate all three of us. We had the same seats for all three games, so we got to know the folks sitting around us, some nice people. It was an almost total sports weekend, with baseball, World Cup soccer, game 7 of the Lakers-Celtics NBA finals, and U.S. Open golf, where my friend Mark Nealy volunteered at Pebble Beach. Pete stayed an extra day and spent it with some friends who studied together for a semester in Spain, all of whom live on the East Coast.
It was a real treat for me that I got to spend Father's day with the boys. We are proud that they are such good fathers to their children. The only downside to the trip is that the Dodgers got swept by the Red Sox, which in the big picture was no big deal.
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