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Sunday, April 9, 2017

Fringeville #162: Leprechauns and Bone Scans

After some fairly regular posts by my standards, I took a little break. It is generally safe to assume that if I am not posting it is for one of two reasons: I am hyper-busy or I am fighting the Universe. It has been a bit of both lately, but much more the latter than the former.

On the busy side, I had some campaign finance and political fundraising stuff to do for some folks. I am one of those odd humans that enjoys that stuff.

On my fighting match with the Universe, I suspect the Universe is winning. It always does, you know. You can’t beat it. It is the struggle that counts. You can lie there and let the Universe kick you while you’re down, or you can tie its shoelaces together so it trips on the next kick and maybe you escape for a bit. (If the Universe is wearing loafers, don’t fret. Have a cat leave a hairball in them. Even the Universe isn’t fond of squishy matter between its toes.)

Bad writing aside, in the end we are defined by how we fight our challenges between the day we’re born and our inevitable dirt nap. The Universe wins in the end, but there’s no reason we can’t kick it in the tenders a few times before the wrestling match ends.

Let’s move on:

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To my vast audience (both of you) there will be a toasted chef post this weekend.  I am leaning towards the one featuring my kitchen apprentice, who had his tonsils out this week and handled it like a champ.

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Because I read a fair amount of Obamacare stuff on my last job, I remembered something that saved me a chunk of money on my taxes, turning a modest refund into one that will cover a mortgage payment.

I did not have health care in January, 2016. I was in the COBRA window from my previous employer, and because of the cost I decided not to exercise that option. My new health care kicked in on February 1, but I retained the option to take COBRA retroactively well past that date. If something happened prior to the new health care kicking in, I would shell out for a month of COBRA. Nothing happened, and I saved money I didn’t need to spend.

Enter the ACA “shared contribution penalty” (i.e. extortion) which is levied on the months you don’t have coverage. At first, it looked like I’d be hit with a nearly $1400 penalty. This is not a year for me to bear that particular burden. My household income is gutted, and I am facing some potentially major, perhaps spectacular headwinds.

Fortunately, a light bulb went off in my head. I remembered reading about the Health Coverage Exemptions (Form 8965 from our pals at the Infernal Revenue Service). For 2016, the penalty can be exempted for up to two months (which must be consecutive) before the extortion begins. I had one month without coverage, and the exemption means that I will have a mortgage payment covered when the refund gets here. It’s a huge break as the Federal government already gets a lot of my income right now. I am still paying down 2015 taxes, paying off a Plus Loan, and then there is the usual paycheck bite. An Obamacare penalty was the very last thing I needed, and I’m glad what I read at some point in 2016 was in the long-term storage bin in my noggin.

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I remember things like the Health Coverage Exemptions because as scatterbrained as I have become, strange little bits of data get lodged in that tiny piece of brain in my skull. When I worked for a major food distribution company, one of my dear friends (hello, Linda) labeled me the “God of Useless Technology.” I remembered all kinds of odd, seemingly useless bits of information about old tech platforms that came in handy at just the right moment.

My talent for remembering bits and pieces of things I've read has served me quite well in my cancer fight. I have been told I am very well read regarding my disease. Which can be good, and bad.

On Tuesday, March 28, I met my new Radiation Oncologist at Geisinger. First off, a nice young lady in blue offered me coffee for the visit. That’s a big frigging deal to me because it is my one remaining vice and right off the bat they were promising to feed it. A guy’s gotta have something.

First came a lengthy discussion with the Physician’s Assistant (PA) and then another detailed conversation with my new doctor. I was extremely well-prepared (a benefit of waking up several times a night and researching until my eyes closed again). The word ‘curable’ was kicked around several times, but now with no guarantees. Being ‘curable’ depends on whether the cancer has remained in the prostate bed and perhaps nearby parts of the pelvis. There would be a bone scan and eventually a CAT scan. We would meet again at the end of April for a planning session. The most probable course: about seven weeks of Monday-Friday radiation plus possibly a course of the antiandrogen agent bicalutamide.

Because of all the bits of research data lodged in my tiny bit of brain, I expressed some concern over hormone therapy side effects. I was assured the side effects I worried most about (possible bone weakening/fractures that some some therapies cause) were not an issue. I have osteogenesis imperfecta, so my bones are already substandard. I don’t need fractures. I was told I have a pretty good chance of developing man-boobs (though there are some pre-treatments that minimize that possibility).

Man-boobs? No biggie. I just figure I’ll wear my wife’s bras and finally convince her to let her own puppies swing free since I’ll be tying up her wardrobe. (NOTE: If she reads this, I want wings served at my funeral brunch.)

Then I asked a question about the likelihood of anything showing up in the bone scan. I was assured that was extremely unlikely, given how my disease was presenting itself. I was told that no one my doctor has treated in a case similar to mine had ever shown evidence of metastasis present on a bone scan this early in the game. It might be hiding somewhere in my bones, but at an undetectable microscopic level. It would be growing so slowly it might never cause me a problem.

For me the bone scan is a big deal, even though it is unlikely to show anything. Why? If there is no detectable spread of my cancer I remain in the curable bucket. I’ll be looking at radiation, antiandrogens, some cute man-boobs and a high probability of dying with prostate cancer, not from it. I will likely choke to death on a chicken wing or chunk of bleu cheese 10, 15 or more years down the road.

But here’s the thing: I am Irish. We are uniquely vulnerable to Murphy’s Law, which accurately predicts catastrophe, generally at the worst possible time. I am also given to premonitions (I’ll save those for some other post) so as soon as I heard how unlikely it was I would have anything of note show up on a bone scan, a thousand bastard leprechauns began hitting their pots of gold with sledgehammers in alarm.

The bone scan was scheduled for the next day, March 29.

I hadn’t heard a thing about the results by the next week so being the impatient little bugger I am, I got on the horn with the doctor. The conversation started just fine. He noted I had arthritis, which I sort of figured, and I started to relax.

“There was some uptake with a vertebrae. I’d like an X-ray of that.”

F**king bastard leprechauns, I hate you.

So, what is “uptake?”

When you have a bone scan, first you get an injection of radioactive tracer. About three hours later you come back for the scan. You lie on a table while the camera moves slowly over your body. If a part of your body doesn’t absorb tracer, that’s a “cold spot” and if a lot of tracer is absorbed (uptake) in an area that’s a “hot spot.” Either flags a potential issue.

I had a hot spot.

Lots of things can cause bone to “uptake” the radioactive tracer. Recent injuries might cause the body to build new bone at the “hot spot.” Perhaps there is a stress fracture or some other benign cause.

The hot spot is in a vertebrae in the thoracic spine. The thoracic spine is one of the more likely areas that prostate cancer moves to when it leaves home to explore the rest of the body.

As of this writing, I don’t have the Xray results. I am considerably nervous. Why? If there is no cancer in my spine, I can dream of remaining in the curable bucket. If it has spread to a distant site in my spine, I have an expiration date and the strategy moves from curing to treating the disease.

I am not frightened. I recognize and accept, as should we all, that no one gets out of life alive. If we all lived forever, where would we ever find a parking space at Walmart?

No, I am anxious. I hate uncertainty. How I conduct my life going forward will be directly influenced by whether I am curable and around a while, or treatable and maybe around not quite so long. Every aspect of my life gets prioritized depending on which way this goes. I already know what I will keep and what I will put aside if the news isn’t good. It is being frozen in uncertainty that drives me nuts.

Wait …do you hear that horrible, gong-like sound? F**king leprechauns.

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Among the things up in the air is my future in politics.

I am on the ballot for Commissioner in Plains, a two-year term. I already know that my love of door-to-door is not going to be a factor. I am going to simply offer a few things for voters to consider: I will not lie to them. If I don’t know the answer to something, I will find out and get back to them. I will work my tuckus off. And I oppose the Penn-East pipeline, something for which Plains and my county take all the risks and reap no rewards. That’s it. No schmoozing, spending money on signs, hosting events, etc.

I know I am going to be around for a 2-year term (unless that chicken wing or piece of bleu cheese gets me), so if that platform is appealing hopefully they’ll vote for me. In any case, this is my last run for office, even if I get good news on the health front.

I have a million other things to write, but this post is already overlong and I apologize for that. Just do me a favor and remember to kick the Universe in the tenders at every opportunity.

Fight hard, friends.

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