End of Life

I received word a couple of days ago that one of my high school classmates does not have long to live. Several years ago she was diagnosed with breast cancer but was able to survive the experience back then. The most recent memory I have of her is from a class reunion where I observed her smoking a cigarette. I must admit, I had a judgment about this. I thought: A cancer survivor. Yet she’s smoking. Incredible. She must have a death wish.

Linda was someone I shared rides with to school in the morning some days (via a carpool). I can’t say that we were really friends, though. We were acquaintances, mostly; we lived in the same neighborhood of our small, rural northern-Wisconsin town and our parents knew each other. She was at least one notch, probably more, above me on the social scale. She was a good looking teenager (rather hot, actually) and dated the jocks. I was extremely average looking, small, non-athletic, academic — and nerdy with a rather rebellious wild side. I didn’t fit. She did.

Now she’s in hospice care. So, again I’m left thinking: what’s this life all about, anyway?

The N-Zone

I’ve talked off and on here about my diagnosis of chronic myofascial pain, provided some thoughts about surviving this disease and the treatment process, and most recently, discussed the trigger-point injection therapy I began a couple of weeks ago.

Here’s a little addendum to the story that I’ll now share with you…

During the first appointment at the doctor’s office where we performed trigger-point injections , skittish-(around-needles)-person that I am, I allowed only four injections. The second time, a few days later, was a session with 19 injections. That extremely-intense ordeal was on a Monday morning, and, as it followed a weekend of suffering through some intense back and foot pain, I experienced some much-needed relief during the course of that day. However, by that evening, I had pretty much returned to “normal.” (This was not a good thing, of course…the pain had returned!) In fact, by the end of the week (on that Friday), I was hurting so much that I made and kept an appointment with my chiropractor in Eugene, where I obtained some pain abatement with the (for me, usual) treatment modes of ultrasound, light massage, and a small chiropractic adjustment.

My injection-therapy doc was going to be out of town for a bit, so the first chance I had to return to him was Monday morning of this week. While there, I reported on my status, including the few-hours-only relief I obtained as a result of the 19 injections last time.

Of course, I had been discouraged at not experiencing more relief as a result of that previous visit, but, still, was rather unprepared for the assessment that injections were not going to be the preferred treatment for me. The “typical patient” tends to respond much more positively than I did, apparently.

I had been warned that this (injection) path might be more problematic for me than others, though. In reporting my medical history, I of course had disclosed that I had been taking lorazepam (“Ativan”) during the last several months in an attempt to cope with the anxiety-factors of my life (job loss, interviewing, moving…that kind of stuff). As it turns out, and as I had been informed, taking a drug in the bezodiazepine class can sometimes (oftentimes) seriously get in the way of having a successful outcome from trigger-point injections. And this doctor, while having treated only a few individuals who were taking (or had taken) this type of drug, had first-hand experience in seeing such cases as mine “fail.” I had been off the drug for a full three weeks at the time of my injections (and, now, as I write this, it’s been over five weeks), but the effect that the drug can have on the body (at least as far as trigger-point injections go) can be much longer lasting than would typically be predicted from the elimination half-life .

So, what to do now? (was the question) I had been studying the Trigger Point Therapy Workbook and doing my own self-massage of trigger points (with the help of a variety of massage “tools” that I now own). But this approach seems to have yielded little progress, especially regarding my back pain. (It’s possible that the condition in my left leg and foot is somewhat improved.)

I asked the doc what we could to do to pursue an alternative treatment path. Fortunately, he had some ideas (several of them, actually). One possible approach that emerged was to take small doses of a drug, naltrexone , once a day (at bedtime) for thirty days. Naltrexone is an “anti-narcotic” usually prescribed to manage alcohol and opiate addiction. However, in low doses (3 mg vs. the typical 50 mg), the drug has been found to be advantageous for a variety of ailments. The hypothesis regarding this drug’s biochemical mechanism (magic?) is that it produces an increase in endorphin levels in the body, which positively impact muscle tissue (and myofascial trigger points, in my case). In people with diseases that are partially or largely triggered by a deficiency of endorphins ( CMP and fibromyalgia are thought to be in this category), or are accelerated by a deficiency of endorphins, restoration of the body’s normal production of endorphins is believed to be the major therapeutic action of (low-dose) naltrexone.

Now, I had never heard of this drug prior to two days ago. But, I admit, this theory and approach are fairly attractive: a low dose of a drug purported to have “no side effects” and that does not involve frequent, multiple and painful needles in my body. Further, the success rate of this approach for individuals with my condition is supposedly quite high (the pharmacist said that, in his experience, this approach works “about 90% of the time”).

I took the first dose last night at bedtime, after discovering that “low-dose naltrexone” (LDN) has its own website and listserv on yahoogroups . I have started to do the reading and the research, though it may be several days before I have any “results” of this experiment to talk about.

Stay tuned for further updates on my naltrexone experience...

Senioritis

Here is a mildly disturbing development in my life...

I drove into town to run an errand during the noon hour today. While there, I decided to have lunch at the Subway shop closest to my apartment. As I was at the register to pay for my turkey sandwich and chips, the young man said, “that’ll be $4.70...or do you do the senior discount?” To which I stammered, “ excuse me ? Uh. No .”

Holy craperino, Batman! This is the first time such a thing has happened to me, and it caught me completely off guard. What, I wondered, about my appearance today , merited this promotion to senior status?!?

Yeah, yeah…I know. I’m 59. I’m an AARP member. I have some gray hair. But, geezzzz. He had to SAY IT OUT LOUD?

Now, I hadn’t had a bad day to that point, and the rest of day went mostly ok too. There is just this one little blip that sticks with me.

Senior discount? Moi?

Anniversary & A Passing

On April 4, 1968, Martin Luther King, Jr., was assassinated in Memphis, TN. Two days later, as the country was experiencing utter turmoil from coast to coast, M and I were married at Trinity Lutheran Church in Eau Claire, WI. If that marriage had lasted, today we would have been celebrating 38 years of married life. Holy smokerinos, do these kinds of thoughts make me feel old!

I now find it interesting that I chose to get married in a year that was one of the most turbulent and definitive ones of the times. M and I went honeymooning when many of the major metropolitan areas of the country were experiencing riots in the aftermath of MLK’s murder. Bobby Kennedy was killed in California just a couple months later; two more months after that was the Democratic National Convention debacle in Chicago. My oh my, the flashbacks I’m having as I write this…

I guess if I can have memories this old, then feeling old, at least at times, isn’t all that surprising.

Lately, the energy I’ve been able to summon to make blog entries (well, actually, just to make it through the day) has waned a tad. Since last week, for sure, I’ve been trying to pace myself even more conscientiously that I usually do. Seeing my life’s blood literally gush from my body in the nosebleed episode had a big impact on me, I think. And, too, I was diagnosed with another eye infection last week. So, I’ve been fighting with that condition, which has led to diminished motivation to stare at a computer screen. Anyway, if you’re out there checking blog entries, you’ll probably have noticed less productivity from ol’ TechnoMonk.

I had a chat with a fellow I work with today. He’s a couple years younger than me, and he disclosed that, physically, he’s been struggling as well. It seems as if his energy level has taken an unexplained, precipitous drop. It wasn’t a gradual thing. Suddenly he’s fatigued all the time. All the medical tests that he’s had so far have turned up nothing; still, this kind of stuff can weigh mightily on one’s mind. I sure know about that firsthand.

It just another example of the fact: we never, really, have any control…

“Seeking security or perfection, rejoicing in feeling confirmed and whole, self-contained and comfortable, is some kind of death…[and is] setting ourselves up for failure, because sooner or later we’re going to have an experience we can’t control: our house will burn down, someone we love is going to die, we’re going to find out we have cancer, a brick is going to fall out of the sky and hit us on the head…to be fully alive, fully human, and completely awake is to be continually thrown out of the nest. To live fully is to be always in no-man’s land…” (Pema Chödrön, When Things Fall Apart, p. 71).

Postscript for the day ... As I was just putting the finishing touches on this entry, the phone rang. My supervisor, who normally does not call me at home, just did. The news is: one of our colleagues, a good man, and a department chair who reported directly to me, died this evening, apparently of a heart-attack. I don’t have the details. I am in shock. More later...

The Class of ‘65

This week I received a CD with the photos from my (40th) high school class reunion, held last July in Rice Lake, Wisconsin. I don’t know exactly what took so long to produce and distribute the disk (they were all straight, un-manipulated digital files), but, at long last, I have the pictures. I went about copying everything to my hard drive, and, with some degree of anxiety, proceeded to take a look.

Here’s just a little bit of the story…

I had believed the journey to Rice Lake for the reunion was going to be a typical one: fly from Portland to Minneapolis (through Denver), rent a car, drive to Rice Lake (about two hours from the airport). It takes most of a day, but it’s always been a pretty manageable trip. Well, this time it was a little different. When I got to the airport here in Portland (early in the morning), the United Airlines kiosk would not allow me to check in. I found out that my flight was, at the very least, going to be significantly delayed, perhaps cancelled. The ticket agent looked for flights for me, and she was immediately able to find ones from Denver to Chicago to Minneapolis much later in the day, leaving only (only?) the leg from here to Denver in question. Well, without going into all the details: I waited and waited, and finally was able to make it to Denver after about a two-hour delay here in Portland. I missed my original connection in Denver, though, and had to wait (nine hours in the Denver airport) for a flight that evening. I had been scheduled to arrive at MSP late afternoon, but instead I arrived at midnight. I waited in line until about 1:00 a.m. before I had my rental car. By then I was thoroughly exhausted, though I started driving anyway. As I was weaving my way out of the airport, I realized that I surely was taking my life in my hands driving in this condition, but pressed on for another half-hour or so until I found a Super 8 that had a vacancy. I checked in around 2:00 a.m., as I recall.

Of course, I was so fatigued and stressed I couldn’t sleep. I tossed and turned until about 9:00 a.m., then slowly gathered myself up to be able to make the rest of the drive. I took the “long way” through Eau Claire, and made it to Rice Lake a little after noon. This calculated out to a full 30 hours from the time I left my house. I had missed the first night of the reunion (Friday), and the second evening’s festivities were scheduled to start in about six hours. I tried to take a nap at my brother’s house, but to no avail. I showered, dressed, dropped by my parents’ house to say hi, and arrived at Lehman’s Supper Club on time.

This was, I think, the fourth class reunion I was about to attend, though the first time I was actually showing up all by myself. I had, on the other occasions, always arranged to be with Bruce and/or Pete, two friends from the class who I’m still in contact with. Pete had remained at home in Arizona, and Bruce, although he was planning to go to the reunion with me, had called me that afternoon from his home in Minneapolis to say that he was sick and wasn’t going to be able to make it.

So, here I was: arriving at the reunion site alone. I had spent more than a full day getting to Rice Lake, on very little sleep. And, as I exited my rental car, I was wondering what the heck I was really doing this for! (This question had always been one that came to me as I arrived at every reunion.) Very likely, the folks in attendance, absent Pete and Bruce, were going to be ones that I had little interest in (and wouldn’t even recognize…thank god for nametags). But, here I was, trying to talk myself into going inside.

It was a long evening, as I hung out a lot longer than I thought was going to happen. And, to make this a manageable length essay, there are just a couple abbreviated stories I’ll relate about the evening…the first pertaining to my anxiety about the event photos.

I spent part of the evening talking to Gary and Diane: two from our class who had married each other. Diane was the class president when we were seniors; Gary was a person I had once worked with at a local grocery store during high-school years. (Oh, yeah, I once had a date with Diane. That happened, I believe, at some point when the two were taking a break from each other during their high-school romance. I recall being pretty infatuated.) Our conversation on this particular reunion night was very “real.” In my fatigued state, I imagine my defenses were at a low level, and when they asked how I was, I told them. I talked about my job uncertainty and stress, and about a years-long relationship that had ended just that spring. I tried to explain to them about my experiences with rejection and heartbreak. I imagine they were outright flabbergasted that I was so forthcoming about the state of my life. This was not, after all, the typical reunion small-talk that was going on all around us. After I had shared a good portion of my story, Gary observed: “no wonder you’ve shown up here tonight looking like you’ve been hit by a truck.”

I think my reaction was a stunned silence: perhaps even tacit agreement given my run-down state. At any rate, that remark is one of my two most memorable events of the night. Actually, it’s one that I could have done without, too. Please, Gary: Hit by a truck? Really? I looked that bad? (I left the building and called it a night shortly after that comment.)

Yeah, and if it really were true, did you have to say it? Geez…I’ve agonized over this for months now. (Very likely because, as I joke around and talk about my experiences at class reunions, I invariably mention that I walk in, look around, and ask myself the question: who the heck are all these old people?)

So, of course, it was Gary’s observation that came to mind as I was starting to browse through the photos taken that evening. I knew I was in at least a couple of them…was I going to see that it really was true? Had I really shown up looking like that?

The other story is a happier memory for me. Earlier in the evening, just about the time we were sitting down to dinner, a woman I had last seen at graduation spotted me from across the room and came over to talk. We chatted for a few minutes at the table, then I got up and walked us over to the other side of the room, away from the dinner activity, affording a modicum of privacy. Jeanie (we called her Carol in high school) was absolutely as delightful — and smart and beautiful — as I had remembered. She was our class valedictorian, and she and I sat next to one another during our graduation ceremony forty years ago; I had not seen her since. We talked about our lives, trying to cram eighty years of collective living into a few minutes. An impossible task. But, I thought our connection during that few minutes was totally delicious. I wouldn’t have missed it for anything. (Jeanie: thanks!)  

Here’s a photo of the two of us. [You decide: “hit by a truck?”]

Jim Arnold & Jeanie DeRousseau
Rice Lake, Wisconsin
July 2, 2005
Photo by Rick Vesper