WA5IYX  Aug 1981


This summary of my recent medical problem(s) is being sent to those kind folks
who've sent various forms of get-well wishes.  If you're squeamish in these
matters, my apologies (I'm not forcing anyone to read this), but hope that
it might answer a lot of speculations & be instructive to some out there.
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First, some medical background and vital statistics: dob: Feb 9, 1947; ht:
5'4" wt: 190's.  My earlier years were notable for frequent upper respiratory
infections ("colds") with a series of strep throats in 1959.  Except for a
severe case of pneumonia in May 1965 (and some "flu", 2-72, 12-75) my health
has been pretty well since 1964.  (Some damaged knee cartilage from May 1960
is still with me.)  My other recent medical (1978-80) attention has been
mostly dental in nature.  The overweight situation (190's early 1971, but in
170's until about 18 months ago) has been around a while.
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Now, this most recent problem arose on Jan 26 with an unremitting &
debilitating sharp pain in my left side.  This was accompanied by a fever,
which, with aspirin was kept in the 99-101 range.  By the 28th it was clear
that this wasn't going to go away on its own so a private doctor was visited.
He couldn't find any immediate cause for that but did discover I was suffering
from a severe case of anemia (normal hematocrit is 0.45 and mine was
0.17-0.20) and strongly suggested that I get to the emergency room of one of
the nearby hospitals in the medical complex.  He supplied a copy of the lab
work results (blood, urine, normal EKG, etc.) to take along.  (At one point
he'd thought I might have kidney problems.)


So, doing that, later in the evening I was admitted via the ER (Rm 917-3) with
great consternation among all as to how I'd gotten to be so anemic (I'd
noticed an increasing tendency to get winded since Nov 1980).  For some time
my acute problem (pain) seemed in their minds to be a secondary concern.

Jan 29: upper G.I. scrubbed since I'd had breakfast; not much done; codene and
	demerol given for pain
Jan 30: temp to 104 in early am; upper endoscopy (fiber-optic tube down throat
	into stomach) very marginal results due to my fever and not being able
	to fully sedate me due to my low breathing (valium, atropine);
	ultra-sound exam (couldn't locate lung fluid); radioisotope exam to
	check for possible pulmonary embolism (not that); pulmunocentesis
	(abt 6 trys of needle thru back to get lung fluid sample before did);
	meanwhile put on 2 liters of oxygen
Jan 31: midnight, 2 units of blood infused (4 hrs); I.V. then filtrated with
	my hand swelling up; reset I.V. in left hand (I'm left handed);
	antibiotics (erythromycin and gentamicin) given for the now-diagnosed
	pneumonia;
(I'm omitting numerous chest X-rays and countless blood samples drawn - venous
as well as the more-painful arterial "sticks").  So with the right hand
swollen and the left taped to a wrist board I had all the manual dexterity of
a lobster (a one-handed one!) (r.h. couldn't even grasp a tissue to pull from
a box).  Eventually hot compresses brought the swelling down.
Feb 1:  as my blood loss had been determined to be from the G.I. tract
	(occult) a proctology exam was done (after laxatives and enemas) to 18
	cm (which revealed what I already knew, massive internal hemorrhoids,
	but little else).  By this time the pain in my left side was virtually
	gone.
Feb 2:  upper G.I. (guzzling barium) (nothing abnormal found in the stomach
	or the duodenum - i.e., no ulcers etc.)
Feb 3:  I.V. removed (free, for a while)
Feb 4:  barium enema cancelled since too much of Feb 2 left in me; more
	laxative/purgatives (magnesium citrate).
Feb 5:  B.E. done; only noticable item "an enlarged ileocecal valve; likely
	due to fatty deposits" - more on that later
Feb 6:  upper endoscopy redone (20-minute view this time instead of 20 seconds
	since I could be fully sedated now) with some old scars (likely
	previous ulcers; I'd an upper G.I. done in Jan 1960 which was normal)
	biopsy OK
Feb 7,8: not much - except I missed the big 6-m events!
Feb 9:  34th birthday; attempt to prepare for colonoscopy by ingesting
	9-liters of 0.9% saline orally in 2 hours but fizzled after only 2
	liters of it swallowed in 3 hours
Feb 10: more laxatives (barium in me from the 5th) and 3 1+ liter colonic
	flush enemas (warm salt water) in 3 hrs; prior to the colonoscope exam
	it had been thought that I'd be discharged on the 11th with the
	hemorrhoids being cited as the cause of my blood loss (and later to
	get them removed meanwhile a high-iron diet); the colonoscope is a
	fiber-optic tube that can traverse the entire length of the colon
	(apx 8 ft); under some atropine/demerol/valium sedation I was still
	awake enough that they let me look thru the "student" viewing head at
	the examination.  Everything was a rather monotonous pink-grey until
	suddenly a rather bright-red structure came into view, and I promptly
	asked, "What's that?"  The answer was quick in coming - it was a tumor
	(small, apx 1" x 2", and from its looks - ulcers on it - not very
	likely a benign one) at the ileocecal valve (where the large and small
	intestines join, near the appendix).  This is likely what the B.E.
	exam of the 5th had shown.  About a dozen biopsy pinches were taken
	(along with several 35-mm Kodachromes).  Regardless of their outcome I
	was going to have to have it removed (a right-hand colectomy) - half
	the colon and some of the small intestine (ileum) removed and the
	"leftovers" being rejoined (anastomosis).  Surgery was contemplated
	in about a week.  There is nothing more convincing than to be able to
	see the tumor in situ - not just a shadow on an X-ray plate.
Feb 11: radioisotope liver-spleen scan done (results normal)
Feb 12: IVP (pyelogram) (iodine dye injected so X-rays can check the ureters
	and kidney conditions) - results normal
	expected biopsy results - adenocarcinoma (i.e., most common colon
	tumor; it had not metastasized from another location)
Feb 13: breathing capacity checked (to see if pneumonia after-effects would
	affect the operating anesthetic (nitrous oxide augmenting sodium
	pentathol); finally moved to the surgery floor (Rm 716-2) in late
	evening (I'd been waiting 3 days for that)
Feb 14: resume liquid diet (which I'd been on about 75% of the time anyway
	since admitted); and laxative preparation for the 17th.
Feb 15: much the same; more colonic flush enemas
Feb 16: more enemas; radioisotope whole-body bone scan done (results OK)
	-detailed discussion of the operation (1% operative mortality)
	-I.V. restarted and massive antibiotics given to cleanse the colon
	(over 2000 mg neomycin and over 1500 mg erythromycin)
Feb 17: 0730 - first case (a carotid artery outpatient who'd had one side
	done 2 weeks ago didn't show up for his); operating time about 2.5 hrs
	(I was awake long enough to hear the EKG beeping away), 2 more units
	of blood; recovery room for some 3 hrs; then to Rm 832-4; the biggest
	immediate post-op problem was severe muscle spasm cramping the abdomen
	(gone in about 1.5 days); lots of demerol injections
Feb 18: urinary catheter removed (flow well maintained); NG (nasal-gastro)
	tube (to siphon out stomach acids etc. until bowel continuity certain)
	a real burden (thru one nostril and down throat) (nice that these were
	installed while I was sedated during the operation!); leaking I.V.
	on one hand removed (had both hands with I.V.'s this time).
	-had to sit up and move about somewhat to keep from getting fever
	(which would indicate a lung problem - pneumonia) and "deep cough"
	(not easy with an NG tube in)
Feb 19/20: pathology results; tumor had penetrated the intestinal wall into
	the fatty tissue (and/or muscle)(Dukes-B); (dropping the 5-year
	survival rates from 95% if it hadn't to 70-75%) but 18 of 18 lymph
	nodes taken out were clean (if not, then 50%) and no liver involvement
	noted (if that, then 30%) - not the best news but far from the worst!
Feb 21: as bowel continuity evidenced (with more than just the gas passage
	I'd waited 4 days for) the NG tube taken out (that helped my ability
	to cough and thus brought down the low fever I'd had since the 17th.)
Feb 22: first liquid food (since 16th) taste and smell acute; then moved to
	Rm 817-4 (ironically one bed from being directly under my first!)
	Drs. say Tuesday likely my discharge date.
Feb 23: I.V. leaking and removed; some solid food in evening (swollen throat
	from NG tube made that rough though); staples removed from my
	incision (about 30 of them; ran about 4" above and below the navel
	mid-line)
Feb 24: more solid meals; expected to get out mid-day but ended up after 1830.
	My pathology results would be given on the 26th to a tumor board
	which would decide any later chemotherapy offerings (see later).

I tried to make this short. If you want more specifics, just drop me a line
with your queries - I wont consider you a sadist or of having a morbid
fixation (at least at first, hi!)

By getting this out (I hoped to do so much sooner) I hope to minimize the
on-the-air discusssions (besides being abhorrent to some and boring to others,
it could also attract the casual tuner-by, and I don't like having to
synopsize these traumatic events too often).  It would be greatly appreciated
if you could pass this along to other persons you think suitably interested
(preferably on the land line - not the local 2-m machine!; or send a copy via
the mail etc.).  In this way, that will get the accurate information around
the widest with the least effort on my part (or any one other person).  I
still don't know just how many 28.885 net participants know that this was a
much larger thing than a case of pneumonia.

I'd figured something like this was in store for me down the line (in about
20 years) as my paternal grandfather had died of a likely prostate tumor (Sep
1954, age 59 yrs) and my father of a pancreatic tumor (Oct 1978, age 57 yr
10 mnt).  But at age 34?

In this I've tried to minimize the verbiage by using the succint medical
terminology (with some brief explanatory notes at times).  So one may have to
use the dictionary (as I did to spell a lot of them!) or even a basic
medical/physiology text at times (useful for diagrams) to get a full view.
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CHEMOTHERAPY:

Apr 2: start regimen of 70-day cycle    (I.V.P. - intravenous push)
	(day 1-5: 600 mg 5-fluorouracil I.V.P.
	day 1 & 36: 1.9 mg vincristine sulphate I.V.P. (Oncovin)
	day 1: 240 mg methyl CCNU, oral
	days 36-40: 700 mg 5-FU I.V.P. )

	with blood samples on days in between to see if the white blood count
	is being depressed too much and adjust the dosage accordingly

	This is contemplated to run 8 cycles (i.e., 1.5 years).  Meanwhile,
	liver-spleen scans and barium enemas at 6-month intervals and a chest
	X-ray every 20 weeks -- to continue for a period of about 5 years.

It seems the side effects vary with each treatment period.  Day 2 is worst
(what with all that day 1 stuff), but some effects linger for a week or 10
days after the last dose.  Already the 36-40 dose has had to be 350 mg because
of my white blood cell count lowering (data: Apr 2: 4300/ml; Apr 21: 3400;
May 5: 3100; Jun 9: 5400; Jul 7 & 14: 2800; Jul 19: ? ... nominal is 7000/ml)

By Jul 7 the hematocrit was up to 37% (0.37) (I had to be at least 0.30 before
surgery could be done); some iron sulphate pills are now being taken 3 times
a day (60 mg each).
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With events after Feb (i.e., the attempted assassinations in DC & Rome) I
imagine a lot more people have become acquainted with some of the medical
proceedures that I'd been thru what with all the detailed news coverage.

Again, my deepest thanks to those who expressed concern last Feb (and to the
many who were probably hesistant to send a card when they learned the more
serious nature of my situation).


73,     WA5IYX  Mr. Pat Dyer
	5315 Silvertip Drive
	San Antonio, Texas 78228

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{This text was originally typed on some 3 legal-sized pages, of which apx 
 two dozen Xerox-copied "sets" were mailed out in the late summer and fall
 of 1981.  The text was copied over to a word processor file in early 1986.}

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