We all walk ancientrails. Welcome to the journey.

Not Gone

Written By: Charles - May• 20•19
Gertie, after the incident

Then there’s Kepler and Gertie. The two of them got jammed up against each other by the back door after Kate fed them lunch. Bloody. Gertie has, again, multiple wounds. A tough situation for us. The incidents are always situational, that is, something unexpected puts the two of them in a tight space or Gertie nips at Kep. Then, full on dog on dog aggression. Well, maybe not full on. Kep never goes for her throat.

We’ve learned from research and from vets that this kind of behavior is not extinguishable. Predator/prey instinct is at the base of the doggy brain, not gone. When it’s triggered, the dog is a hunter, or a self defender, both behaviors beyond any executive function that might have been trained into them.

Kep last week

We love both of them. Not rational, but we’re going to keep them both. In Tully’s case her Wolfhound on Whippet aggression was not situational. It was fully switched on and we had to keep them separate at all times. This was years ago, but we faced the same dilemma. We love Tully, we love Kona and Hilo. So, we managed it.

The Kep situation is, in some ways, tougher since it’s unpredictable. 99% of the time he and Gertie play, eat together, rest together. Are genuinely friendly with no residuals from Kep’s biting. Then, bam!

I’m keeping them apart right now. Kep’s up here in the loft as I write, wandering around since he’s usually not up here for any length of time. He prefers being outside.

And so close to Memorial Day

Written By: Charles - May• 19•19

A Winter Storm Watch is in effect for the Front Range ABOVE 9,000 feet and the High Country.

A strong storm system will move into Colorado on Monday and continue to affect the area into Tuesday. This system may bring heavy snow to the mountains and northern foothills from Monday afternoon into Tuesday with several inches of wet snow possible.

Heavy snow possible. Total snow accumulations of 8 to 16 inches possible with up to 20 inches in some mountain areas. Winds could gust as high as 35 mph.

* WHERE…Rabbit Ears Pass, Rocky Mountain National Park and the Medicine Bow Range, The Mountains of Summit County, the Mosquito Range, and the Indian Peaks and The Northern Front Range Foothills.

* WHEN…From Monday afternoon through Tuesday afternoon.

* ADDITIONAL DETAILS…Travel could be very difficult. The hazardous conditions could impact the morning or evening commute.

Zhuangzi on fate

Written By: Charles - May• 19•19
2014

Made potato, corn, bacon chowder last night. It took longer to make than I intuited from reading the recipe, but it was worth it. Kate finds good recipes, I cook’em.

She also cleaned up the kitchen last night. Her stamina and strength have both improved so much. She builds on it by regular p.t. and using her rollator less and less.

Decided two things yesterday. I’m not going to expect support, but I’ll appreciate it when it comes. Also, what’s good for the dogs is good for their human friend. I kept their routines as normal as possible while Kate was in the hospital and at rehab. I’m going to stick with cooking, working out, reading, writing Ancientrails, working on my novels, painting, going to CBE, seeing the grandkids. The usual stuff. With one exception. I want to go hiking more. Shinrin-yoku. Forest bathing.

Wu Zhen. Fisherman. ca.1350. Metropolitan Museum N-Y

In other words, I’m going to live my life. It’s one that’s fed me, kept me sane, allowed me to make contributions to others, to create, to love.

I remember a story about Chuang Tzu, a Taoist sage. Also written as Zhuangzi. Here it is:

“Zhuangzi’s wife died. When Huizu went to convey his condolences, he found Zhuangzi sitting with his legs sprawled out, pounding on a tub and singing. “You lived with her, she brought up your children and grew old,” said Huizu. “It should be enough simply not to weep at her death. But pounding on a tub and singing – this is going too far, isn’t it?”

Zhuangzi said, “You’re wrong. When she first died, do you think I didn’t grieve like anyone else? But I looked back to her beginning and the time before she was born. Not only the time before she was born, but the time before she had a body. Not only the time before she had a body, but the time before she had a spirit. In the midst of the jumble of wonder and mystery a change took place and she had a spirit. Another change and she had a body. Another change and she was born. Now there’s been another change and she’s dead. It’s just like the progression of the four seasons, spring, summer, fall, winter.

“Now she’s going to lie down peacefully in a vast room. If I were to follow after her bawling and sobbing, it would show that I don’t understand anything about fate. So I stopped.”

by Tom Crane

And so it is with my cancer. However it turns out, it’s nothing more than the Great Wheel turning. Excuse me while I go get a tub and a wooden spoon.

Get Your Hands Dirty

Written By: Charles - May• 18•19

Just to show you I’m not only about death and cancer. Here’s a response I wrote to Bill Schmidt after reading this article, “Modernity, Faith, and Martin Buber,” from the New Yorker. He passed it along from his friend Nancy.

Bill, it took me a while, but I did get around to the Buber article yesterday. Interesting. I’d not read a synopsis like this before.

He was a contemporary of Mordecai Kaplan, the founder of Reconstructionist Judaism and the only rabbi excommunicated by the Orthodox rabbinate in the U.S. My kinda guy.

Martin Buber


I would put Buber, Dewey, Kaplan, and Emerson together. They all questioned received wisdom, hankered to get below the surface of thought to find the substrata. Dewey (and William James) as a pragmatist might be the outlier here, but the pragmatists were a unique American contribution to Western philosophy and as such took issue with the philosophical tradition they had been given from European thinkers. Buber, of course, is the only one of the three that is not an American, but he took Jewish thought in a direction I think is very congenial with Kaplan.

In a quick search I couldn’t find any evidence that Kaplan used Buber’s work, but their mutual insistence on a human centered approach to religion, perhaps even in Buber a human/pagan approach: “When something does emerge from among things, something living, and becomes a being for me… It is for me nothing but You!” and on Judaism’s culture, as opposed to dogma, makes them simpatico. “Buber exhorted his listeners…not to abandon their Judaism but to reinvent it.” Reconstruct it.

This is congruent, too, with Emerson who wanted a book of revelation to us, not the dry bones of revelation to them. Emerson I know had a lot of Taoist influence, don’t know about Buber.

Mordecai Kaplan

We might find a distinctly American twist on religious sensibility by looking at all of these thinkers, even though Buber was German. I’d say my project about reimagining or reinventing faith is in this tradition. That tradition seems to say, take nothing from books as true. Test their ideas against reality, test them against reality at its deepest in your Self and at its broadest in the world beyond the Self. Be ready for the sacred to surprise you in the petals of a flower, the flow of an avalanche, the innocence of a puppy. Find the divine within your Self and bow to the divine within the other, be it rock, animal, fungus, or human.

The gooseberries and me

In my work I’ve found the soil, the power of plants, perfect examples. When we consider our reliance on the first six inches of top soil, on the mystery of photosynthesis, on the divine miracle that is life whether green or furry or pink or barked, then, we don’t need to go to Luke or the Torah. My scripture and its most profound secrets exist in the wonder of rootlets reaching into the dark for the nutrients held for them in living soil.

Are you going to be o.k.?

Written By: Charles - May• 18•19

Mortality signals. Coming through loud and strong. A frisson of the world without me. “Are you going to be ok,” Kate asked, “Psychologically?” “Yeah, I think so. I’ll tell you if I’m not.”

Yamantaka

Hard to avoid running the recent news all the way out to the literal end. (see post below) I’m neither a pessimist nor an optimist, I’m a realist. The indicators are not good. But. At this point that’s all they are. Indicators. As Kate also said, “We need more data.” Yes, an axumin scan would have helped, but a ct and an mri will get us started.

Yamantaka and I have been friends for a long time now. I’ve imagined my death, my corpse. Meditated on it. When my mind insists on following the bread crumbs, I let it. I end up the same place Yamantaka has taken me. The same place we all come to. The question isn’t whether, but when.

Yes, this is morbid. And, yes, even if all the signs are negative, nothing’s happening soon. But I can’t be other than where I am. Right now, on this chilly May Saturday, I’m still absorbing.

I do feel I’ll be ok. Psychologically. Which doesn’t mean I won’t be scared. The unknown is the landscape between here and death. Will treatments be able to slow down the cancer? Is there still a chance for a cure? Unknown.

There a couple of mantras I’ve said over and over for quite a while. Live until you die. I intend to do that. Live in the present. I’m doing that except for those pesky moments when the blood hound of logic starts baying at the trail. I still have books to write, paintings to finish, friends and family. Dogs. Those will not change. Books to read. Places to go. Mountains and nearby states to explore.

On that last. I will see the National Gallery of Art in Taipei. This is the museum which contains the Qing emperors collection, all the best of Chinese art over its long history. Chiang Kai-Shek gathered the collection and took it with him to Taiwan after a losing fight against Mao and the Red Army.

Here is a large copy of one piece I most want to see:

Fan Kuan, Travelers with Mountains and Streams, Song Dynasty

Oh, I see

Written By: Charles - May• 17•19

So. Saw Dr. Gilroy, the radiation oncologist. His office, appropriately, is close to Skyridge Hospital where I left my prostate 4 years ago. Gilroy is a man in his 50’s, a friendly broad face, short cut but curly hair, a thick, but not fat body, and a kind demeanor.

Still hoping to dodge the bullet

All the folks at Anova have been kind. Which helps. Kate was there, sitting second chair this time, as I’ve done for her appointments over the last year. These patient rooms are the same. An exam table, two chairs for the patient and support person, a stool and a small desk projecting from the wall, a computer. Sometimes drug company posters on the wall: Pulmonary Hypertension and You, How to rate your bowel movements, Glaucoma and the eye. Bland wall colors. Sensible carpet. A sense of depersonalization. The focus is on you, the sick one. Or, the maybe sick one.

The news so far is sobering. The rise from .1 in January of 2018 to 1.3 in February of this year is rapid according to Gilroy. The velocity of the rise can be an indicator of the severity of the reemergence.

“Have you had a digital exam since your prostatectomy?” In this case of course digital means, with a digit. “No.” “I need to do one.” “Oh.” “Drop your trousers and bend over the exam table.” And so I did.

He could find no nodules. Had he found one he said it would have indicated the likelihood of a localized reemergence. Rapid velocity. No digitally findable nodules. Could mean metastases.

Next up are the traditional imaging techniques. CT and MRI. The MRI scans bones for mets and the CT looks for what I’m not sure. Next week sometime.

I’m not afraid to die. But. I’m not eager either. The gap between those two does produce a quickening, a stomach drop, but I’m not experiencing, nor do I expect to experience, dread. Into each life a little death must fall.

Immoral and Barbaric

Written By: Charles - May• 17•19
CBE and visitors

It’s been warm, even hot down the hill. When I went to the Avengers movie, it was 85 when I came out. Largest temperature swing I can recall. It was 66 when I got back to Shadow Mountain. Not a fan of the heat.

Kate went to the board meeting at CBE last night. She stayed for the whole time, three hours. Her stamina has improved a great deal and she’s using her rollator less and less.

Just put the all season tires in the truck. Headed to Stevinson’s this morning to replace the snow tires and get some dye in the air conditioning system. We’re gonna fix the air conditioning one way or the other this time.

Then, Anova Cancer Care at 12:30. Told Kate yesterday that I want definitive treatment rather than quick treatment. My anxiety level is low. Doesn’t mean I’m not feeling some stress. Of course I am. Just not projecting outcomes, results. So, Dr. Gilroy, here we come.

I did see this yesterday, Judge rips insurance company: “A federal judge blasted UnitedHealthcare last month for its “immoral and barbaric” denials of treatment for cancer patients. He made the comments in recusing himself from hearing a class-action lawsuit because of his own cancer battle — and in so doing thrust himself into a heated debate in the oncology world.” The issues are slightly different, but guess which insurance carrier I have?Immo

The Doris Day Lifeway

Written By: Charles - May• 16•19

Beltane                                                                             Cancer Moon

cinema avengers-infinity-war3Saw Avengers: Endgame on Tuesday. This was to distract me from being pissed at Centura Health, United Health Care and whoever else dragged their feet, waiting until the day before and the day of to interfere with my planned axumin scan. It worked. I know who dies in endgame, but I won’t tell. It’s a long movie and I’m not a super fan, so I know I missed a lot of the inside jokes and things being tidied up from the multiple movies that preceded it. I did, however, come out calm. The universe had been returned to mostly normal, seder had been restored. The underlying reason we like superheroes, mysteries, thrillers.

By that evening I was sufficiently chill to sleep through the night, something I almost never do. I spoke my mind to the health “benefits” folks at Centura Health, distracted myself, got some perspective, and slept just fine. Not  deep breaths or wonky meditation, but workable.

glaucoma-and-eye-pressure-800-latestYesterday I focused on an organ, the eye. Played space invaders for the nice man, or, as they insist on calling it, a visual field test. My field of vision is holding steady, no glaucoma encroachment. Pressures are good, the hole in my cornea is, as my ophthalmologist says, is patent. That means it’s still draining the fluid for me. Part of me, an important part, is functional and remaining so. With help from latanoprost and good surveillance.

Joy

Joy

On Friday I see the Anova Cancer Care folks. This will be a somewhat changed consult since I didn’t do the axumin scan. I plan to ask them what sort of imaging work will make their work optimal. If they believe in the axumin scan enough, I may agree to pay for it. $4,000 versus life? Not a tough call.

After lungs on Monday morning, a crowning achievement on Monday afternoon, the scan hooha on Tuesday, the glaucoma checkup yesterday, and the oncologist visit tomorrow afternoon, we’ll have finished off another very medical week. Something fun is in order for the weekend.

virtues doris-day-59053Simcha. I’m coming to believe that joy and gratitude may be sufficient to get us all the way through life. I don’t mean silly puffy gladness, or just saying thank you reflexively, but heart and mind illuminating joy and deeply felt gratitude.

What gives you joy? Be grateful for it. I’m gonna call this the Doris Day lifeway, worthy of emulation.

 

 

Tear Down That Wall

Written By: Charles - May• 15•19

Beltane                                                                        Cancer Moon

cancer who decidesNo scan. AARP Secure Horizons denied payment. When I asked how much it would be as a self pay. Pet scan, $2,600, axium dose somewhere between $1,000 and $3,000. Nope. And, I made the decision for the same reason AARP probably did. The scan’s accuracy is around 60% and that goes down the lower the PSA. My PSA is well above the reemergence marker of .2 at 1.3, but it’s still pretty low for imaging studies.

What makes me angry about this is that I scheduled this scan on April 25th. That’s twenty days ago. If they’d come up with these problems even last week, I’d have had a chance to call the insurance company and Dr. Eigner, Dr. Gilroy, see if something could be done; or, if it was clear no payment option existed, what new imaging studies I could have. Now I still have to do all that, but 20 days after I put this study on my calendar. Meanwhile those little cancer cells don’t care. They just go right on chasing immortality at the expense of my health.

I had an image yesterday of our health care, that is, doctors, nurses, labs, hospitals. The entire province of folks and structures who provide medical services. They’re all there, most of them competent, capable people who got into medicine to help people, to cure illness. Now. Imagine all of those people and their support behind a huge wall, a really huge wall, the best wall possible.

cancer universal health careOn this side of the wall, where you and I are, is the money used to pay everybody in medicine. If you are a one percenter, there’s a special gate you can walk through anytime you need it. You can access all of the excellent care that is available. If you’re the rest of us, no money passes through the wall unless several corporate, bureaucratic entities and individual people within them, say yes. Those entities include private, for-profit health insurance companies, medicare, medicaid, non-profit health insurance, banks, credit card companies.

According to this CNBC article, $3.4 trillion dollars pass from the money side of the wall to the health care delivery side of the wall each year. That’s $3.4 trillion. In this interesting nyt article, author Matt Bruenig makes a case for treating health insurance premiums that employees pay for company insurance plans as taxes. He makes this claim: “Moving from our system to a European-style system would make our overall system of taxes and health insurance payments much more progressive for the majority of Americans, because the elimination of private health premiums would more than offset the rise in formal taxes for all but the wealthy.”

cancer insSuch a shift would eliminate all of the corporate gate-keepers who have an interest in profit for their company. Perhaps they could all go work for the TSA and use their previous employment experience to annoy the hell out of travelers.

Would such a change mean I get my scan? Not necessarily. There would still be assessments made about the appropriateness of particular care; but, those decisions would be made by people who have my health and the health of our medical system at heart, not the wallets of investors. In that case I’d trust a decision to withhold the scan as a considered one based on those criteria, not on what’s best for United Health Care’s bottom line.

Health Care in the USA

Written By: Charles - May• 14•19

Beltane                                                                    Cancer Moon

climate change vollmanHere is a cautionary tale about health care. On April 24th or 25th I scheduled my axumin scan for today. That’s twenty days ago. It’s purpose is to tell where my cancer reemergence is located and to help stage it. This after the rise in PSA caused consternation for both me and my urologist, Dr. Eigner. I was glad we could get it on the calendar so quickly.

Yesterday, after we got home from Dr. Gupta’s there were two messages on the phone. One was an “urgent” message from the hospital health benefits department. The double speak in the system unveiled itself when the “benefits” person told me they did not have approval for my scan. This is at 11:30 am the day before the scan. Eigner didn’t get the information to the insurance company in a timely fashion, they said. The insurance company, which claimed to have 72 hours to make a decision couldn’t make one in time.

I could come in today, they said, and sign a waiver for self-pay and await the decision or I could reschedule. If you recall, the axumin isotope is in limited production. The hospital only gets a dose once a week. There was no certainty about when I could reschedule either. They put me in a box by waiting until midday of the day before the scan. It’s possible the insurance company could deny it. It’s new, though not experimental.

axiumShould I go in today, sign the waiver, and keep my appointment with the radiation oncologist on Friday? When I told Eigner my PSA rise, he said, “Get another PSA done and get into see me ASAP.” A post-prostatectomy rise in the PSA to .2 is a biochemical recurrence. That’s the clinical definition. Mine was at 1.3. Everyone I spoke with had a sense of urgency about this. That made me have one, too.

I’m going in, gonna sign the waiver. My concern level, for myself, is high. I’m distracted. An occasional feeling of dread passes through me, floats my stomach. It’s fear of the unknown. Though I’m not afraid to die, I’m not eager, either. In this case it seems that time matters. At least to me.

I did not need to worry about money, too. This problem cranked up my anxiety level by putting another weight on the scale. Not. Needed.