The Cancer Frog Blog

The last blog entry ended with Dr. Marie Mulligan saying the following, “You are not really the type I associate with this kind of cancer – it tends to appear in women with a lot of stress.”

She does not know that during the several years preceding my diagnosis, my brothers and I had been taking care of my parents whose health and well being were rapidly declining.

It all started when my father called. “Your mother is leaving me.”
“Dad, what are you talking about – after all these years?”
“No, no that’s not what I mean. I dropped her at the doctor’s office the other day and she went to the wrong clinic. She doesn’t know where she is.” I hop on a plane immediately and when I get to my parents’ house, no one answers when I ring the bell. I go in and discover my father trying to pull my mother out of bed. She has projectile vomiting. The bedroom reeks of urine. I start to call an ambulance. “No, we don’t need one,” says my father and I realize the depth of his denial. At the hospital, they discover Mom has gone septic from a urinary tract infection (UTI). She recovers but begins a steady cognitive decline. After much discussion, my father agrees to sell the house and move into assisted living to be near us. I make repeated trips back and forth across the country, organize 3 estate sales and watch my mother shrug her shoulders as people leave with her treasured collections of copper pots, blown glass, African masks, and beads.

One day, back at home, I notice that I have a rash covering my entire body. The doctor says “I don’t know what it is, we can take a biopsy.” The biopsy comes back negative. “It’s some kind of auto-immune problem. “Could it be caused by stress? I ask. “No,” he says, “definitely not.” My friend Dr. Beverley Kane, says “The skin is the first line of defense.” She suggests that I contact another forward thinking scientist who recommends reading, The Genie in Your Genes.

It is about epigenetics – the idea that there are environmental forces acting upon genes that cause them to mutate, to manifest or not manifest. “Environment” can mean the emotional state of the person, which in turn causes chemical changes in the body, which in turn effect genetic behavior and disease. The book sites studies with couples upon whom small wounds are inflicted – scratches. One set of couples is exposed to stress, another not. The wounds of the stressed couple heal more slowly than the wounds of the unstressed couple. So can one extrapolate from this that if a cell’s genes have a mutant cancer sequence, this can be suppressed until some change in the cell’s chemical contents enable the cancer to manifest? My rash remains for over a year. It disappears after we get my parents settled into assisted living.

My brothers and I still have plenty of stress, trying to manage my parents’ care. My mother calls her living space “this lousy apartment.” One day she asks, “Why don’t you have a baby for me to play with?” She forgets that I am well past menopause. There are so many ways in which I have failed her expectations.

Her health is fragile. She gets one UTI after another. We ask the doctor how we can prevent these infections from recurring. He stands at the foot of her bed and says, “She has to die of something.” The first neurologist she sees suggests looking into new medications for Alzheimer’s. “What are some?” I ask. “Look it up on the internet,” he says.

At the assisted living facility, a compassionate but disorganized health care manager engages in ongoing conflicts with the owners. We look for an alternatives, but my father has dug in. He doesn’t want to move, doesn’t think anywhere else will be an improvement. Two years into my parents’ stay, he has a stroke. As a result, he cannot swallow properly, his speech is slurred, but he remains mentally acute. Within a short time he can walk and speak more clearly. His swallowing never improves and there is a danger that he will inhale food into his lungs and die of pneumonia. He has a stomach tube inserted for nourishment. He hates the stomach tube, hates having an aid administer the feeding. The more he loses control over personal tasks, the grumpier he gets. He practices his own private form of Judaism. I give him Jeanne and William Steig’s book, “The Old Testament Made Easy,” thinking it will make him laugh. Instead he complains, “There’s a mistake. Steig drew Adam with a belly button.”

We visit another neurologist to get to the bottom of my mother’s cognitive wasting. “She is losing tissue,” he says, and points to dark smudges on her brain scan. She slips further and further away, stops talking, withdraws from my father. One day I bring her Chinese food for lunch. She eats it, falls asleep, awakens for dinner. She sits with other barely cognitive patients. Suddenly her head drops to the side.

We rush her to the hospital. A nurse slaps her hand and calls her, “Shirley, Shirley!” She opens her round blue eyes and smiles, lifts her hand to the nurses cheek and strokes it. I want it to be my cheek, I want to be touched by her, seen by her one last time. I am on the wrong side of the bed; I wouldn’t have the nerve to disturb her sleep. The nurse smiles back. Mom’s hand drops down. She closes her eyes.

The doctor says “We’ll keep her on fluids for three days. Sometimes people come back. If not, you can withdraw fluids and she will die within two weeks.” She never comes back. We decide to let our mother die of thirst and hunger. We call hospice and sit vigil. We give her oxygen to ease her breathing; we change her fentanol patches. If she seems restless, we put morphine under her tongue. We swab her gums with a soft lollipop-like green sponge on a stick, to moisten her mouth. How do you know whether you are adequately controlling the pain of someone who has fallen through the black holes in her brain? The hospice nurse tells us the signs to watch for. “Her feet will turn blue, her breathing will become sparse and rough, she will exhale and die.” On the ninth day we surround her: my father, my two brothers, the hospice nurse, and I. I count her breaths per minute. Her toes are blue, her breath a harsh cackle. We tell her how much we love her and reassure her that it is okay to let go. She inhales and dies.

My father falls into despair. He decides to have his stomach tube, the one good source of nourishment removed. He becomes emaciated and weak. One day I come into his room and he is folded chest to knees in his wheel chair, clutching tax papers in his left hand. He looks dead. I put my hand on his back, “Dad, Dad?” He sits up. “Dad, are you okay? I wish you would let someone else do your taxes.” He is a numbers man, a statistician. He is stubborn about doing his own taxes. “No, I’m not okay. The taxes aren’t the problem,” he says. “It’s my body. I’m dying.” The next day my brother takes him to the doctor, who encourages him to eat more. He dies in his bathroom that afternoon, alone, after my brother leaves. By the time I get there, my brothers have laid him out on his narrow bed.

He lies, arms and legs akimbo, his position evocative.

No Holy Mother holds him aloft. A fierce believer in the unity of G-d, my father would have been horrified that the Pieta even crossed my mind. He was also fiercely pragmatic, “Once you are dead, you are dead, kaput, finished, nothing.”

Jews do not believe in preserving corpses with embalming fluids or elaborate coffins. They return to earth in a plain wooden box. My parents went even further.  They donated their bodies to science. Each was wheeled into a non-descript van, driven to a morgue, then transported to a medical school. I have no idea what happened to them there, what happened to them when the students were finished with them.  “There isn’t a grave, an urn of ashes,” says my brother, “just nothing .”

A month later we discover that someone walked by my dead father, into his room, stole his credit card and used it to buy gas and dog food.

I have to wonder whether my stress caused the skin rash, whether it allowed my body’s chemicals to get so out of balance that it triggered the cancer. Who can know to what degree we influence our own health. My surgeon believes I can have no influence on whether or not the cancer returns. He says this as though it should be a relief to me. I settle on something in between – try not to worry about the cancer returning and buy all the vegetables, cook books and algae that Dr. Mulligan recommends – and especially the Maitaki mushrooms to prepare for the radiation.

I am at the airport on my way to the Las Vegas Gift Show for work. Though pre loaded with things to read, I survey the new stand for something better, Science Magazine. I flip though the pages. A smear of green sugar icing topped with little purple grapes pops off a two page spread.  It has a strange sci-fi beauty. The caption reads “Invasion of the Bleb.”

It is an electron microscopy image taken by master photographer, Anne Weston, EM Unit, Cancer Research UK. This little landscape is a lung cancer cell. Anne has dyed the cell to better differentiate the little balls or as they are officially called, “blebs” from the cell surface.  The blebs are bubbles that form when a cell divides or undergoes stress. I guess one could classify uncontrolled cell division as stress. Scientists use images like this one to examine cancer’s disruption of normal cell function. pg 8 Science, March/April 2010.

I try to contact Anne Weston when I get home to see if I can use the image here in the blog. The first Anne Weston I see on Facebook has the American Cancer Society listed as a favorite organization. I think that I have found the photographer and send her an email. Instead, I have coincidentally come across the art director for the American Cancer Society publication, Triumph! By researching more electron microscopy sites, I find the photographer, Anne Weston and she kindly agrees to let me publish her image. If you would like to see more fantastic images of hers and other scientists cum artists, please visit Visuals Unlimited at http://www.visualsunlimited.com/c/visualsunlimited and the Wellcome Image Library at http://medphoto.wellcome.ac.uk/

Once in Vegas, I meet up with Prima Entrepreneur Margaret Majua, for whom I do design work. We are looking for ideas and products for her stores.  The gift show sprawls in typical Vegas extravagance across three conventions centers. Glittery bling, hippo netsuke, walky talky dinosaurs, military fashion wear, Prada purses, kitsch of all kinds adorn the aisles. We buy the remote controlled dinosaurs because anything that moves, sells. We also look for sayings magnets and I see this one:

I keep staring at it, trying to figure out the point of view of its creator, and finally decide that it is one of those numbing conundrums, like “This sentence is false.”

We walk up and down the aisles until my eyes and feet ache equally. Suddenly I am stunned:

The Booth is called Wild Creations. 4” x 4” x 6” aquariums line the shelves. In each are two of my cousins, African Dwarf Frogs, about 1.5” long, hind legs kicking furiously, front feet scraping the sides of their plexiglass prison. A young man hands out fliers touting these so called “EcoAquariums™ as having been nominated “Toy of the Year” by the Toy Industry Association, Inc..  The brochure quotes Julie J. Charlotte, NC, “The best product I’ve ever used in my classroom to teach kids about ecosystems.” Ecosystem??? The choices for the aquarium are either 4” x 4” x 4” or 4” x 4” x 6” with decorative gravel or rock, living bamboo, and Living Gravel™.  The brochure goes on, “There is nothing like our EcoAquarium™. Change the water twice a year . . . feed the frogs twice a week. All of the living elements inside the EcoAquarium contribute to the needs of each other.  The frogs and snail in the aquarium consume oxygen and produce carbon dioxide.  Naturally occurring bacteria in the Living Gravel convert ammonia from animal waste and left over food into nitrates.  These by-products provide food and nutrients for the living plants and algae, which in turn produce oxygen through photosynthesis.  Through this cycle a balanced ecosystem is created.”

Here is what I found out about African Dwarf Frogs:

“These semi-scavengers should be fed every alternate day . . . The African dwarf frogs need to be kept in a large tank of 10-gallon or more .  .  .  the African dwarf frog is a rather timid and shy amphibian . . . it is  essential to provide these amphibian lots of hiding places.” http://www.aquaticcommunity.com/frogs-turtles/africandwarffrog.php

These frogs are together in about 3 cups of water. they have no place to hide and they look miserable.

“These are inhumane and I do not approve of them,” I say to the salesman, as though I am Oprah and my opinion will determine his success or failure. “Okay’” he says, and smiles knowing he has “one of the highest grossing products per sq. ft. in stores today” (also in their brochure).

We have an extra day in Las Vegas and tour the Valley of Fire, a flaming sandstone expanse that bursts up out of the Nevada desert.

Thanks to the movement of tectonic plates, the grey limestone mountains surrounding the valley will eventually bury it. There are Anasazi petroglyphs scratched onto some of the wall faces. This one shows my species:

In addition to petroglyphs, the guide points out creosote bush.

“Cup your hands over some leaves, smell them, then exhale and smell again.” We do this. At first the leaves have no odor, but after we exhale, they open their cells to suck in the moisture from our breath, and emit a subtly pungent odor. A little miracle. “The creosote bush has nothing to do with creosote, except for its odor but does have medicinal uses and is being studied for uses in cancer treatment.” This sounds like something I should verify and discover that researchers have performed experiments with an acid extracted from the creosote bush “that corroborate(s) its chemopreventive potential against skin cancer.”
1Department of Medical Elementology and Toxicology, Hamdard University, New Delhi 110062, India, 2Department of Pharmaceutical Sciences, Medical University of South Carolina, Charleston, SC 29425, USA and 3Department of Neurophysiology, Leibniz Institute for Neurobiology, Brenneckestrasse 6, Magdeburg D-39118, Germany

I also read this: “The creosote plant was a virtual pharmacy for Native Americans and the steam from the leaves was inhaled to relieve congestion. It was also used in the form of a medicinal tea to cure such ailments as flu, stomach cramps, cancer, coughs, colds, and others.” Phil Persson, a resident of Phoenix http://phoenix.about.com/cs/desert/a/creosote.htm

There are surprises for me when I return to California. It has rained every day while I have been gone. When I go out, I notice some long black dotted strands of slime in the rain puddles. At first I think they are some awful horse worm.

Remember my distant cousin, the Western Toad?

It turns out these are her eggs (or her sister’s):

There are more in a second puddle, and in a third, hatched tadpoles. I start tracking the progression.

Hatchlings on their egg tube:

Close up of hatchlings looking embryonic:

Within 2-3 days, they are swimmers with fins. BTW, that other little green thing in the human hand is also a creature!

Small guys compared to the older tadpoles I find in the second puddle. Note that the fins are gone:

Tadpole Pin-up

I read on a creature info site (http://www.fishpondinfo.com, developed by Robyn Rhudy) that zero to ten out of all the hundreds of eggs a toad lays will mature to adult hood – Zero because the toad may have chosen an inopportune place to lay – very likely in California where rain is sparse and puddles have an unpredictable duration. There are three puddles on my property. All start to dry up before a single tadpole matures. The shallowest dries up a few days after the rain. I rescue some of its hatchlings, scoop them into a plastic container with mud, algae and rocks, but leave most to die. I rescue every single one of the larger tadpoles in the second puddle – put them in a kiddie swimming pool. Out of the third puddle, I place the unhatched egg strands in a separate container so I can track them from tadpole to toadom. The third puddle is the largest. I rescue many of the swimmers, even buy a second kiddie pool; but most die in the drying mud.

I notice that the tadpoles from a single puddle and presumably the same egg strand develop at different rates – possibly as much as this:

These are not from my control group so I cannot be sure they came from the same strand. I will survey my control group and compare them as they grow.

I am not good at survival of the fittest. The fact that I have made it into my late 50’s is by the grace of niche markets, compassionate friends and family, and some lucky stumbling. The TV Show “The Weakest Link” seemed mean-spirited to me. I hate Donald Trump’s “The Apprentice.” It is as Darwinian as the baboon downing the baby Gazelle, the upstart cabochin monkey killing its pack leader. The fact that my cancer was not papillary serous, that I came out of the surgery and returned to relative robustness, that I earn a living and can draw using computer tools – all of this seems to be the result of luck, not willfulness. When I tell a friend, a doctor whom I haven’t seen for 20 years, that I survived cancer, he says, “Nu, so you’ll die of something else!”

My need to save all the tadpoles is a fool’s errand – by averting one calamity I am postponing or causing another. I scoop up one bunch of tadpoles and not another. Death is delayed longer for the scooped up bunch. Eventually they will succumb to cannibalism, predatory attack, lack of food or water, will get run over by a truck, or die of old age (unlikely). My surgeon, the oncology team at Kaiser, scooped me up.

I find an ant who has met some accident. It is curled into a ball and cannot unfurl its body, though it waves its legs with great intention. The humane thing to do is smash it, put it out of its misery. But I wait in cowardice long enough for a puff of wind to carry it away, leave it to its painful fate.

Cancer  quotidienne is my new nomenclature for serendipitous mentions of cancer in the media.  In a March 2010 issue of the New Yorker: Joseph Papp (Joseph Papirofsky), died of prostate cancer October 31, 1991. What he did during his lifetime – turned the old Astor Library into one of the most prestigious theater venues in New York – The Public Theater, “responsible for among others, the original productions of “Hair,” “A Chorus Line,” “The Normal Heart,” and “That Championship Season.”

The next FrogBlog entry will be back on track with the cancer story continued. Sometimes I cannot help myself by yielding to distraction – and my fascination with worlds under the radar.

Tadpole close-up; nostrils, eyes, pupils and sparkly irises: