Last week I had a CT scan and appointment with my oncologist at Hopkins. Good news - my tumor has shrunk slightly and there are no new ones, the four rounds of chemo in September and October seem to have been effective. The bad news is that he suggested that I do 8-12 more rounds, though he did recommend a 20% lower dose. But ugh, nevertheless.

So in the new tradition of shopping for a "yes", I went to see my local oncologist, Dr. Wadlow, who oversees my chemo treatments. Dr. Wadlow, as I have mentioned before is heir to Drs. Ben Casey and Kildaire in charisma and compassion, so I was hoping for a more palatable recommendation. And I got it; he suggested that I move to oral chemotherapy, with a daily dose of Xeloda, which is one of the four nasty concoctions that I've been taking in the previous chemo sessions. He is concerned that the Folfirinox (the acronym for all four drugs) treatments have been taking too much of a toll on my body in terms of neuropathy, bone marrow depletion, etc, not to mention making me a depressed and crabby old fart.

So, on Monday I will start with Xeloda. It has possible side effects, too: fatigue, mouth sores, hand irritation, and diarrhea, to name just a few. But still it should be much easier than Folfirinox. So, I am relieved and feeling positive about going forward. In fact I feel better today than I have since August. With luck the side effects will be minimal, and I can manage this indefinitely. Stay tuned, and a Happy Thanksgiving to you all! We have much to be thankful for.

Body Chemistry

A few weeks ago I started chemotherapy again for the second time, the first being in 2015 when I underwent twelve rounds to treat pancreatic cancer. It went about as I expected. During the 48 hours of infusions and the following two days, I felt heavily drugged and crushingly fatigued, and my stomach churned with nausea and diarrhea. I spent most of five days in bed. Since the fifth day I have gradually gotten better, though my energy level is still low and I continue to have stomach discomfort. I feel pretty good now, nine days since the infusions ended, so I was recovered enough to do it all again the following Monday. But chemotherapy certainly hasn’t gotten any easier this second time around.

I’ve been thinking a lot about the chemicals in our bodies this week, and coincidentally I read a couple of interesting articles that further stimulated my thoughts. I was trying to put all of it together into a coherent essay, but I’ve decided to not worry about coherency and just start writing.

About three days into chemo I started taking OxyContin again. I took Oxy throughout chemotherapy in my year of pancreatic cancer; the pancreatic tumors gave me a unique searing pain in my upper abdomen, and Oxy really helped with that as well as simply making me feel better. I found pretty quickly that if I missed a dose, not only was the pain more troubling, but also I felt headachy, lethargic and depressed. In other words, I became dependent on the drug pretty quickly. Back in 2015 I was concerned about how I would get off of it when the time came, but at that point I was a lot more focused on other things like whether I would be alive long enough to care. Eventually I was taking 30 milligrams a day, a relatively small dose. And about a month after surgery in the winter 2016, I was able to stop taking Oxy without too much difficulty, I just dealt with a few days of sleeping poorly and feeling irritable.

This time around I am not having any cancer-related pain, but I was feeling really drained and depressed   last week and experiencing the queasiness and cramping in my gut, so I tried Oxy anyway. I immediately felt much better; the gut clenching and nausea stopped, and I felt more alert and vital. So I’ve continued to take it, and it really helps, and I can feel the difference when it wears off. I still worry about becoming addicted, but let me tell you, when you feel lousy and depressed and you know there is a little white pill upstairs on the night table that will fix it, you don’t second guess for very long.

One of the things I noticed the first time I went through chemo was that the chemicals suppressed my testosterone, and I observed several interesting effects. Of course, I also thought I might be dying, so it’s not very clear what was causing what. But, I saw that I became a lot more emotional; I felt more affection toward the people around me and my world. I also felt more sadness, and I reacted more to events in the world. I stopped watching movies and TV shows, they affected me more and I couldn’t stop the images from flooding my brain. I also became more passive and agreeable, I couldn’t stand any sort of conflict. With my new passivity, I remember thinking on many occasions, why can’t we all just get along; there is so much to be grateful for, what is there to fight about?

As I have written before, the year of cancer was emotionally overwhelming. I go back and read my blogs and it brings me to tears still.

After surgery in January of 2016 I went through a period of depression, which I learned is almost a given after what I had gone through, so I tried taking Zoloft for a while to address it. I didn’t like it, I thought it made me duller and less energetic and it didn’t seem to help with my depression. My anti-depressants made me more depressed. I stopped after a few months.

Gradually I felt better, though I have still never regained the vitality of my old life. (Maybe being 60 has something to do with it too?) But by the time a year had rolled around, when I had fully recovered and stopped taking all of the narcotics, I also found that I was becoming more aggressive again. I became more competitive and argumentative; I found that I was getting more worked up at my daughter’s soccer games, and bickering more with my family. I could actually observe my personality changing.

One of the models that I have constructed over my life by which I try to make sense of human behavior is that I see men as always being in a state of balance between our competitive side and our belonging side. On the competitive side we are aggressive, driven creatures who are always trying to gain the upper hand on our peers and rivals; on the belonging side, we are loving, caring beings who are devoted to our families and friends and would even stake our lives to protect them.  It seems apparent that both sides have been necessary to support survival and growth of the human species; we are aggressive so that we can meet our desires to attract the most suitable mate and to grow and protect our families; and we are also social and cooperative so we can harness the power of tribes and communities and live together in harmony. I have come to see it as a yin-yang between wanting to love our brothers but still establish dominance over them. It is why we can go out on the rugby field and bash our heads together until the blood runs streaming down our necks, then go to a bar afterwards and stand on the tables, and sing together until the cops arrive (a most memorable day I experienced that helped me put the finishing touches on this model.) I’m sure it’s also why, among other things, women find us incomprehensible.

As for women, I believe they also have some of this yin-yang between competitiveness and caring, but perhaps less so than men. I don’t feel as confident in my model when it comes to women; I don’t really understand how women think and I never have and never will.

None of these ideas are new or surprising or original; I’m sure I’ve cobbled the together from a variety of sources. But it is a model that is very useful for me when I try to understand why we men do the things we do.

One of the glib comments I make when I am describing this model to friends is that just about every bad thing that has ever happened to me has come from my competitive side, and just about every good thing has come from my cooperative side. True? I don’t know, but I have been thinking about it a lot. What if all the rotten stuff men do, cheating and fighting and raping and plundering and warring, all come from that competitive side and our need to be the alpha male? What if we could do away with it?

We seem to worship it in our culture. I remember thinking as a teenager, near the end of the hippie period, that we had moved on to an era when men had learned that being more “manly” was not the answer, that we were learning to make love, not war. That we had entered an era of enlightenment, where men would communicate more honestly and freely, and treat women as equals, and nurture living things instead of destroying them. Sadly, it seems to me that we instead moved in the opposite direction. Manhood today seems to be about body-building and six-pack abs and in-your-face tattoos, and buzz cuts. Not to mention that acquiring wealth and displaying it proudly has never been more in style. It’s pretty clear to me that the culture turned away from ideals of The Great Awakening of the 60’s, that today is all about becoming stronger, meaner, and more ruthless; and loving your brother is for wimps.

I’m sure there are many men who would hear my views with disgust: just more evidence of the pussification of America. I’m sure they would say it was the will of men that tamed the planet and shaped it to our needs. Where would society be without testosterone and the drive to be the alpha? Who would build things and innovate and create a culture of production and consumption? By God, we are men, this is our birthright! We build this world, with its great technology and its indulgences and the opportunities to satisfy our animal desires. Without men and our lust for greatness, what kind of world would it be?

What kind, indeed, I wonder. I am very concerned about the future of human beings on planet Earth. I believe the challenges that loom ahead of us are daunting: climate change, overpopulation and resource shortages, the threat of nuclear confrontation, the possibility of untreatable diseases and pandemics. All of these are, at their roots, driven by the animal instincts of men, for more power, more wealth, more indulgences, and more trophies of status. Our culture sneers at the notion of living in harmony with our environment; we believe we are too smart to be held back by the mere constraints of nature and that we can always innovate our way out of any problems we create along the way. And so we grow and consume at an ever more voracious rate, with world population nearing 8 billion, soon to be 10, soon to be 12 or 15 billion people, without a thought that this planet simply cannot support that many human beings. I am so concerned about the future for our children, and indeed, our entire species.

I didn’t really intend to go off on a rant about the end of civilization. This piece is supposed to be about how we are all really just big sacks of chemicals, and though we think we are creatures of free will and thought, changing that mix can change who we are. As I write this I am in now in the later stage of my two week chemo cycle; my stomach is churning like a garbage disposal full of gravel, I have a persistent throbbing headache, and when I close my eyes I feel like I’m on a gently rolling lake. Chemo-state reminds me most of one of those really special hangovers that come from mixing all three of the major alcohol groups, which I guess is fitting since chemotherapy is just another type of chemical poisoning, in my case with four different powerful drugs. I’m a very different person during chemotherapy: passive, jittery, depressed, and very anxious. If someone so much as raises his or her voice around me it throws me into a tailspin.

Perhaps the most difficult part of it all is the depression. The chemicals seem to have been formulated to produce a constant, penetrating state of depression. My chemo mind is hyperactive, and the thoughts that keep churning are sadness, worthlessness, frustration, regret, fear - a whole cornucopia of desperation. I know these thoughts are not “real”, that they are drug-induced and not responses to outside stimuli, so I feel like I should be able to will my way through them, to accept that this is just what the drugs do. But they are persistent, vicious little buggers.

When I was young and foolish I experimented with recreational drugs, including one I choose not to name. My first experience with it was an awesome, enlightening ride; I reached a state where I suddenly knew that human beings were truly beautiful and that I felt love for us all. I could see that most, if not all of us, had shielded our inner beauty under shells of cynicism and mistrust; but I could also see that we all have the capacity to shed those shells and express our inner perfection. I felt that we had a common connection, that we had evolved from a core organism that had shared it’s essence with us all. Of course I did eventually come down and I resumed seeing the people around me as I had always seen them before, but the most wonderful and profound thing was that I remembered what it felt like to see them as holy and beautiful. And I have never forgotten to this day that we are all essentially beautiful creatures who have the capacity for pure love and perfection, despite the shells that we build up around us.

Since then I have read many articles about this type of drug, and the accounts from people who have tried them seem to be overwhelmingly positive. So many of them report reaching a similar state of bliss, of it being one of the greatest experiences of their lives. Their accounts seem very similar to mine, that they felt an outpouring of love and a sense of oneness with people and the earth. More recently, I’ve read of research that shows these drugs have been very effective at treating profound depression and post-traumatic stress syndrome. These chemicals seem to have extraordinary potential for good.

I don’t know what else to say about that. We live in a culture where taking the drug I described is a federal crime, even smoking a joint is still illegal in most places. But drinking alcohol is heavily promoted, and opiates are so easily available that millions of Americans have crippling addictions. So we Americans don’t have an aversion to taking drugs, we just choose the ones that cause ruinous addiction and generate enormous profits over the ones that produce serenity and bliss. Sometimes I wonder what would happen if we just put the stuff in the water, wouldn’t that be an interesting experiment?

Of course the most important way in which we acquire the chemicals in our bodies is by the foods we eat. I’m sure that most everyone understands now our food is less nutritious and full of lots more questionable stuff than the more natural plants and animals that our ancestors ate. In light of that, I was impressed and uplifted by this article about how The Netherlands is at the forefront of efforts to improve farm productivity and improve the quality of their output: http://www.nationalgeographic.com/magazine/2017/09/holland-agriculture-sustainable-farming/. It’s nice that we are reaching widespread awareness about the importance of eating better, but efforts like these are still very few and far-between.

And, shortly after I read that one, I came upon this depressing piece about a new scourge that is impacting the nutritional value of our crops: http://www.politico.com/agenda/story/2017/09/13/food-nutrients-carbon-dioxide-000511. Just one more effect of climate change that millions of Trump-supporting Americans can dismiss as a libtard plot to enrich those money-grubbing scientists (and Al Gore).

Finally, there was this disturbing article about the decline of insect populations in Germany: https://www.washingtonpost.com/world/europe/buzz-off-german-study-finds-dramatic-insect-decline/2017/10/19/6a087d40-b4c8-11e7-9b93-b97043e57a22_story.html?utm_term=.8c337edf1410. It doesn’t really fit with my theme of chemicals, but it is peripheral to a couple other things I touched on. And it does seem to be pretty important.

So that is my rambling piece on chemistry. I do wonder if we could change the world if we could somehow reformulate ourselves to be more caring, loving creatures. But I suspect that most people would think I’ve lost my mind. It’s quite likely that I have.