Saratoga Springs

This morning, after having my blood platelets level checked at MSK to see how I am reacting to the daily injections of blood thinner, Susan and I drove up to Saratoga Springs, New York. The racing starts Wednesday and continues through the Labor Day weekend.  I have been coming to Saratoga for the racing since 1963, and Susan started coming here with me a few years later. There are more important races at Saratoga than there are at any other race meet of comparable duration. Saratoga also features races for two-year-olds. I particularly enjoy going to the walking ring before the maiden races (i.e., races for horses which have never won a race) for two-year-olds to try to identify future stars among the horses that have not yet raced and to study the characteristics of the progeny of young stallions.

Just before I got my cancer diagnosis, we had rented an apartment in Saratoga for the entire racing season. One of the things that we had wanted to do when I retired was to spend as much of the racing season up here as we pleased. In addition to the horse-related activities, there is plenty to occupy one's time in Saratoga. When I was working, we drove back and forth between New York City and Saratoga on weekends. If possible, I also took a vacation for the entire week during which the Saratoga yearling auctions are conducted. Often, I bid on several yearlings and bought one or two. 

This year, we can stay in Saratoga only through August 1, as I have to get back to New York City for my surgery on August 3.  Although I am still limited in my activities by back spasms, and dopey from the medicine that I am taking for the back spasms,  we will just make the best of these next few days.

Bad Habits Die Hard

In getting exercise, when I act both as the athlete manqué and as my own trainer or coach, stupidity tends to prevail. My instinct is to push constantly for personal bests, even though I try to tell myself to go slowly and not experience a setback by injuring myself. On Saturday and on Sunday morning, as part of each of the three two-and-a-half mile walks that I took, I climbed up and down a staircase with 57 steps. I put aside the knowledge that I am still very weak from my June 15 surgery, and I mused about whether I should try to get each walk up to five miles before my surgery on August 3. 

Now I am nearly immobilized by pain in my lower back, which I am not permitted by the doctors to treat with anti-inflammatory medications. I hope that this self-inflicted problem does not compromise my stamina too much heading into the surgery, or leave me to deal with a combination of abdominal and back pain after the surgery. I hope also that the back pain does not curtail either my ability to see people before the surgery or our plan to go up to Saratoga Springs for four days before the surgery. 

Tom Watson

Tom Watson is the only top tournament golfer I have met. Eleven years ago, the night after he won his last PGA tournament, the Colonial, I happened to be seated next to him at a dinner at the Links Club in New York at which he was the guest of honor. It was considered a remarkable feat for him to have won a PGA tournament at the age of 48. I found him to be a good dinner companion-- dignified, personable, and interested in more than just himself and golf. Thus, I was not surprised that he conducted himself so well today after his crushing failure to maintain his lead-- at age 59, with a recent hip replacement-- on the final hole of the British Open. One could not help comparing and contrasting his demeanor with Tiger Woods' swearing and pounding the tee box with his club after hitting a bad shot in the same tournament. 

"It's an Ill Wind that Blows No Good"

For the first time this year, I visited the glaucoma specialist whom I had been seeing every two months for eight or nine years. Interestingly, my intraocular pressure was the lowest that it has ever been (that's a good thing), and my visual field test seemed to indicate somewhat less damage than previously (which I'm not sure is possible, as dead neural ganglion cells don't revive or get replaced). Glaucoma is thought by at least some specialists to be an autoimmune disease, and chemotherapy suppresses the immune system. Thus, chemotherapy may be efficacious for glaucoma-- or, at least, my chemotherapy regimen may be beneficial for my particular type of glaucoma. Until I got cancer, my only material ailment was glaucoma, which is to some extent heritable and from which my mother is now legally blind. In addition, my father suffers from wet macular degeneration, which makes it more likely than otherwise that my siblings and I will develop that cause of even more blindness than glaucoma. Thus, prior to my cancer diagnosis, I had worried about outliving my eyesight.

Over the last few days, although I am still instructed not to lift anything over five pounds in weight, my strength and stamina seem to be returning more rapidly than heretofore since the surgery. Today, I took advantage of beautful weather and walked over five miles, including two separate walks of two-and-a-half miles along the pathway paralleling the East River. It is a very nice walk, as I have to cross only two through streets going out and coming back. A highlight of the walk is an enclosed dog run, in which the dogs always seem to be frolicking together. I suppose they fight with each other sometimes; but as I walk by, I haven't seen or heard any signs of quarreling.

My Mother's Birthday

Today is my mother's 95th birthday. She and my father and sister are going out to dinner to celebrate at the Ponte Vedra Club. 

Susan and I and a friend went out to Belmont Park today to watch one of our horses, Hot Money, run in a stakes race restricted to three-year-old horses bred in New York. Hot Money was the 4-to-5 favorite in a field of nine. He finished next to last. 

Yesterday, I received a call from MSK that the radiologist reviewing the CT scan that I underwent the previous day had detected a pulmonary embolus-- a blood clot-- caught in the IV filter that had been inserted in my vena cava when the doctors had earlier found a blood clot in my right leg. These blood clots are almost certainly a result of my cancer. Such clots must be treated, as they cause heart attacks and strokes. Starting yesterday, I am now injecting myself once a day in my stomach with a blood thinner, a low molecular weight heparin called Dalteparin or Fragemin. I will have to have my blood platelets checked twice a week at MSK. Starting today, I began wearing compression hosiery, which I found to be hot and uncomfortable. (I can't get them to stay up. Maybe they're the wrong size-- or maybe I need a garter belt.) Because I am now on a blood thinner, I can no longer take anti-inflammatory medications like NSAIDs (aspirin, Ibuprofen, etc.) or Celebrex to control the arthritis in my hip. A primary concern for me is whether either the blood clots or the blood thinner will preclude certain chemotherapy options. In any event, I will now have to continue to be treated for blood clots for a minimum of six months. Subsequently, if I were no longer deemed to have active cancer, such treatment could be discontinued.

A New View

The feature article on page D 1 of today's (July 14th's) "Personal Journal" section of The Wall Street Journal is entitled, "A New View, After Diagnosis. Experimental Group Therapy Aims to Help Cancer Patients Find Meaning in Face of Mortality." 

http://online.wsj.com/article/SB20001424052970203547904574276434196118914.html#mod=todays_us_nonsub_pj

The article discusses an experimental program at Memorial Sloan Kettering aimed at helping "cancer patients find a sense of meaning, peace and purpose in their lives, even as the end approaches." The program is based in part on the writings of Victor Frankl, specifically Man's Search for Meaning. As I have written previously in this blog, particularly on March 20, one of my first thoughts when I got my cancer diagnosis was to go home and start re-reading Frankl to help structure my thinking about my short remaining lifespan. I count myself as fortunate that I had read this book, and therefore was aware of it as a resource, prior to my diagnosis.

Today, I spent the day at MSK having my liver and general condition tested and examined. It seems that the right lobe of my liver is atrophying and the left lobe of my liver is growing in line with expectations. Moreover, even though I am appalled at my loss of condition this calendar year, the doctors and nurses seem to think that I am rebounding exceptionally well from my first surgery. Thus, the tentative August 3 date for my next surgery is now a firm target.

The doctors and nurses cannot figure out what caused the skin around, and particularly below, my surgical incision to become hypersensitive, then peel and become pink and itchy. The best guess seems to be that the trauma of the surgery triggered a mild case of shingles--a  mild case because I had been vaccinated for shingles. Whatever caused this condition, it seems to be running its course and is now only a minor irritation. I am hoping that the next surgery will not cause it to flare up again, as a mere touch of cloth to my abdominal region was difficult to bear, which  interfered with my sleep and added to my pain when forcing myself to walk for exercise.

A Little Progress

After a wet, cold spring, the last few days' weather in New York City has been sunny, with low humidity, and temperatures not exceeding around 80 degrees. I had enough energy on Friday to visit Belmont Park to see the two horses that we have stabled there currently. On Saturday, I went out to lunch with a friend who very kindly drove into Manhattan to see me. Today, I took three walks totaling, according to my pedometer, 2.45 miles.

Since Friday, the nursing service has had to come only once a day, instead of twice a day, to dress my infected incision. With luck, the incision will heal not only before my next surgery, but also in time for me to go up to Saratoga Springs for a few days prior to the surgery.

Halfway Point

It has been 24 days since my first surgery, and my second surgery is scheduled 25 days from now. Candidly, I am dismayed by how weak I find myself. Yesterday, I had lunch at my apartment with my brother, Bill, who drove up from Virginia to see me, and I was so exhausted afterwards that I had to take a nap. Today, I went out to a local restaurant for lunch with a friend and got so tired that I developed an upper back spasm, which thwarted my plan to be driven out this afternoon to Belmont Park to see my two-year-old colt, Backslider. Backslider arrived from Kentucky two days ago to be prepared for his racing debut on July 23 at Belmont Park. 

It is amazing how fast, and to what extent, a sequence of cancer, chemotherapy, surgery, and an infection can debilitate one's body. Since the surgery, I have lost nine pounds, and I would not be surprised if all of the weight lost has been in the form of muscle. At least the post-surgical swelling of my abdomen has receded enough so that I was able to wear a pair of trousers when I went out to lunch today that I was wearing before the surgery.

I need to get much stronger over the next 25 days before undergoing the second surgery. In the meantime, I will try to husband my strength enough to enable me to go out to Belmont in the next couple of days to see Backslider. After I had to cancel my visit today, my trainer, Christophe Clement, very kindly sent me these two photographs of Backslider. Obviously, Backslider is still growing, as his hindquarters are higher than his withers. But he looks strong, and my guess is that he will mature into a grand-looking colt.

Update

Gradually, my energy and stamina seem to be improving. I am no longer taking medication for pain or antibiotics for the infection of the incision. Although the infected part of the incision is slowly healing, it still requires the services of a visiting nurse twice a day. The swelling of my abdomen has subsided enough to enable me to wear newly purchased khaki trousers only four inches larger in the waistline than I wore prior to the surgery. The skin below the incision was irritated from something during the surgery, and that skin irritation does not seem to have lessened. I will have to find out if the surgeon can safely modify the next surgical procedure to avoid a recurrence of that skin problem.  Next Tuesday, I will undergo a day of tests to ascertain that I am on track for the second surgery to take place on August 3.

Starting tomorrow, I am going to start seeing visitors again. I will not be able to do much on visits-- my longest walks since surgery have not exceeded 1.4 miles, and I more typically have been taking walks of a half mile or so. Most foods no longer taste good to me, apparently because of what is transpiring with my liver as its right lobe atrophies. But I am looking forward to being with friends again, if only to talk.