Monday, July 21, 2014

Sugarland Express

One lump or two?

Bobby's family and and a cousin or two were all jammed into the back of a 67 Plymouth station wagon,  at the Evans drive in watching "Sugarland Express", a  film by an unknown director name Steven Spielberg  in which a young desperate couple kidnap a Texas highway patrolman (based on a true story) to try to get thier baby back from child services. In fact it was this director's first film, and starred a sexy young actress named Goldie Hawn. Unfolding on the big screen, was the biggest car chase ever seen in the movies up until that time, truly America's biggest car chase, if you will.

  Then it happened. Bobby was chewing on a handful of Dots gumdrops, just
stuffing his cheeks when sheer TERROR swept over him. There it was right there
in his cheek... A LUMP. He swallowed all the candy...but it was sure still there, plain as day. On the
left side, just below the corner of his mouth. He had been learning about cancer at school from his  6th grade science teacher Bette Davis, whose sister in Galveston was fighting cancer. Her cancer had
started out as a lump on her neck. a salivary gland,maybe.   Could this be the same
thing? This lump in his cheek, marble size, just like Mrs Davis' sister?!?!?!?!.

It actually rolled around when pressed.      Sheer Panic! 
Was it  a tumor? Was it the C word? Maybe it was... it was ...SOAP Poisoning!
Oops. Wrong movie. That's Christmas Story.
So, here we are. This life long fear rearing it's ugly head, a real life monster under the
bed... this "evil nugget" as Kelly calls it.
In the 90's Bobby's Osteopathic doctor surgically removed a lipoma from the back
of his head. (A Lipoma is a fatty tumor. They are not considered dangerous.)
It came back. She named it "Herman". She took  out again. Guess
what? It came back yet again and again!  The doctor ended up removing Herman
4 times in her back surgery room in her office. The 4th time was a charm. It was
always was benign, but it was a great relief just to be symetrical again. He got the damn thing
in the first place because Donnie Cushman, mess specialist seaman apprentice on
the USS Pluck used to call Chief Wiesen "lumphead". The Chief was Bobby's first
Mess Chief in 1981 when he first reported aboard for duty. He had a lump on his
head, behind his right ear.Right where Herman showed up.
Bobby never scolded or chewed out Donnie for calling
Chief Wiesen "Lumphead"(Bobby out ranked him by 3 steps) . For this, Karma rewarded Bobby with Herman the lipoma from HELL. Damn these lumps. Damn them.
Sharon named this rib lesionn "Lester Diamond" , as in 'leeching lytic lesion' or simply useless, a bum. A parasite...

 (Apologies to James Woods, Casino).
Hopefully they will soon be changing his name to Lester the Benign Lesion.

Benign. Benigno. Bene. Buono. Bon. Giorno. Bongiorno.
Bongiorno to the evil nugget. Tomorrow the 22nd. New wing of the Anschutz

inpatient pavillion, AKA the AIP at 7:30 am. Check in is at 5:30. in the AM.  Sheesh!
NPO starts at 9:30 this evening. Early bird gets the... lesion. 


Wednesday, July 16, 2014


56...    Fiddlesticks!

 56. What a number. Let me explain...On the evening of December 9th, 2007, Notbillybob (Bobby) kissed his wife goodnight,  rolls over to his left side, and plopped down in the bed to go sleep. There was an audible CRACK-ing noise. He jumped up out of bed, screaming-I BROKE MY RIB-I BROKE MY RIB-I BROKE MY RIB!!! Early the next morning they went to the ER , and got and x ray. Nothing. Impression,negative. No broken bone. 10 days passed. The pain was much worse. It's the Friday before Christmas, his primary care doctor says "sometimes a broken bone won't show up until it starts to knit...she sends them to a different ER at a different hospital. The report comes in just as her staff is closing up for the holidays.  Bingooo. Broken rib. Positive X ray. Miserable Christmas dinner, but OH so glad that there was now proof he wasn't making it up.
 There is nothing worse that complaining to a doctor that you have a pain, and they cannot find a reason. They write in your chart "idiopathic" which is Greek for "unknown". The *other doctors see that and immediately they think Munchhausen!

*ER doctors 

After the rib healed,  Not billybob thought the matter was over... until it broke again.
 And again.     A n d . . .a g a i n.
 Over and over, this rib would break, and worse and worse the pain would get.  Some years it would break up to 4 times. Bedridden for a week, then better and better till the next time. You can look down through the posts to see this.

Then one day Notbillybob went to the "U"   (Colorado University Hospital) October 2010 for a routine screen for liver cancer .
One of them there Cat scans. One of these every 6 months had become routine. This blog has little radiological symbols all over the place as a result. I think  it's because Notbillybob thinks that the Radiology department is his home away from home. Heh heh.  Anyhow, this screening report was alarming. Possible small liver tumor, AND a slowly enlarging lytic lesion on the
7th anteriolateral rib (means 7th front-side rib) which was the one which kept on breaking over and over. It was a bone tumor- growing bigger and bigger. Lytic means "destructive". They sent Notbillybob to the Rocky Mountain Cancer Center for a follow up. The doctors there ordered every test in the book. A bone scan. A barium swallow. Chest x ray survey.
Ya da ya da ya da ya da. 
 November 2012 rolls around and another Cat scan. The
thing has just gotten HUGE.  

By now, 5 separate doctors have refused to either do
a biopsy or surgically remove it.  Notbillybob wasn't in any shoot-fired hurry to go
the the operating table anyway. Liver doctor had said surgery  for cirrhosis patient is extra risky. Risk from anesthesia to the liver, risk of bleeding, etc.

Another Cat scan this past April showed that the lesion is now a huge TUMOR, and has broken through the bone.It's very close to his heart. It cannot stay, because it might be malignant.

 The differential diagnoses are almost all carcinomas.  (Differential diagnosis is a fancy way of saying "It could be ___")  The doctor cannot say for sure, because even though the usual blood markers do not indicate a cancerous presence, the only way to know for sure is a biopsy on the whole thing. Looks like a chicken leg.. or a lightbulb. Notbillybob and Sharon named the thing "Lester Diamond. From the movie "Casino".  The surgeon wanted it out ASAP. But Notbillybob wanted to wait till later in the summer.  Tuesday July 22nd is the day.
Now for the kicker. Starting a year and a half ago, Notbillybob's platelet count 
has been going down. A little at first, then more and more.  Supposed to be 150 at
the lowest. Was 151 for years years. Now, it's going down.145... More. 100, 97, 78, 69, 67, he developed a low platelet rash called petichia. Little tiny hemorrages in the skin.


 Last week, got some bloodwork done. uh oh.
Bad news. platelet count-----56. Really? 
56. (it means 56 thousand). Better if it were 156 thousand. Much much better. But I guess we'll take the fiddysixx and run with it.
 Tommorrow morning at 9:00 am Notbillybob goes in for the pre-op. 
See you at the "U".

Testing HTML for facebook.


Why is text underlined?
This is a test to see what a blogpost will look like in facebook. Will I need a 3rd party app??
Will it be as difficult as it used to be?? Quare faciem tuam, ut auctor libri inimicum?

Sunday, July 13, 2014

Tuesday, June 10, 2014

This blog is not scary, says Billybob


For "Notbillybob's" Ma...

This is a key to the symbolism used in this blog. 
"Notbillybob" is planning some posts to help people keep up on current events. There are some things...
But still, it isn't scary here. There are other blogs much much more scary. Like the evening news. LOL.
Dark liver humor.  Bill

Saturday, September 15, 2012

AA Birthday Number 6 and "The Taste", revisited

Welcome to Billybob's Wildride! There will probably be a bunch of first time wild riders since Bobby plans to post this on Facebook for the first time, So let me introduce myself. I am Billybob, the wacky liver living in Bobby's upper left quadrant. Bobby started the "wildride" back in '07 to vent and communicate to people about the *wild ride*, but hardly ever posts on here anymore. Unless a CT scan comes back positive for a liver tumor, or bone tumor, or when he has some additional strange and bizarre medical diagnosis, and the once a year AA birthday. Which is today. Number 6. -6 years or 2192 days or 52,608 hours or 3,156,480 minutes...without a beer!! (or any other alcohol)
So, to celebrate number 6, we are going to repost one way back from AA birthday number 2. Happy birthday, you big ol' lunker, and many more to come! Love, Billybob , the Lung brothers, mister HEART, the Gutz family, Mr. Spleen Mcqueen, Kidney one and Kidney two, "the Zombie monster" rib tumor, De Quervains pains, and all the Piggies who went to market!

THE TASTE- by Billybob September 1, 2008
Six years and two weeks ago (September 10, 2006), Bobby kissed Sharon bye, grabbed his keys and headed out the door. He was on his way up to Golden, to Mount Olivet cemetery to visit Ardis' grave for just the second time. He stopped on his way at a convenience store for a can of beer and a pack of smokes. Back then beer was not available on Sunday, except the watered down version, 3.2 beer, because of blue laws, or unless you went to the bar. Bobby and Sharon live one block from a bar, but he never took advantage of it. Only an alcoholic would do that, right? He bought a pack of cigarettes, and a 24 ounce can of Budweiser. The clerk handed him his change, and he wheeled out the door, the cemetery being only a couple of blocks west. He had taken his fishing chair with him, and expected to stay awhile. He dismounted from the truck, the cemetery was vacant. He could not see anybody else, it being Labor day weekend, and a Sunday, the sun was warm, but not too hot, and the sky had an autumn feel to it. .. The fresh sod on her grave was taking hold now, beginning to knit after just 3 weeks. The fishing chair sunk in to the ground because the grass being over watered. He adjusted it, and managed to stop sinking. He had already lost 50 pounds on his way to lose a total of over one hundred in just 4 months. The abdominal pain had changed in intensity over the last month. It felt as if a dirty brick had been surgically placed in his abdomen. Every movement and vibration hurt.
He had been trying to drown his emotional pain, but it increased his physical pain. It burned now. That weekend, he had not drunk any beer, unheard of for labor day weekend . He had been telling Sharon that he was close to quitting. Ardis' dying had convinced him to quit. He didn't want to die like her. A year prior, his brother had questioned him at the request of Sharon, about weather he though he had a drinking problem or not. He had come up with a logical explanation to Jeff as to why he did not have a drinking problem. People who have real drinking problems can't switch to 3.2 on Bronco Sunday at dad's house, and they can't ever stop at just one or two, right? Bobby had started buying 3.2 for the Bronco game since becoming very very drunk during the Denver bronco's loss to the Jacksonville Jaguars a few years back, and enduring a lecture from his father. He was embarrassed by it, so he made it a point to never take regular beer over there again. But lately, even 3.2 beer was getting him drunk, and he marveled at how amazing that was. So, he cracked this ice cold can of Bud, lit a smoke, and inhaled, and as he let out the smoke, he told himself to really take it in, the feeling. The taste. This was an experiment to really contemplate life and death. A taste test, if you will. Sitting here on Ardis' grave, pissed at the whole world because of his false perception that no one really knew or cared how much her death had destroyed him and Sharon, he drank. He smoked.
He knew that his liver (me) was very sick. So far the doctors were all being fooled into thinking that I was fine, but Bobby knew better. Today, he enjoyed this feeling, and most of all, this taste. Just for a while longer. He had a saying back in his 20's that a cold beer, and a Marlboro were life's end all beat all, and that he wanted them as a dying wish. But today, he knew he would have to choose. If he chose the beer, he knew he would be giving up Sharon, but every time recently he had asked her if she was at the end of her rope, she just patiently said "not today, hun". She had been so patient in the weeks following Ardis death, especially since he was on a real bender and he had never done this before. He felt completely out of control. Like a car coming down a mountain with no brakes. He knew that choosing the beer meant choosing death.
He gathered his cigarette butts, his empty can, and paper bag, and sat in the bed of the truck for awhile. The equivalent of two cans of beer never used to have this effect, but he didn't feel safe to drive, so he waited. He waited the prescribed amount of time required by law. More proof of not being an alcoholic,right? When he got home, he didn't have any thing more to drink the rest of the night. Yet more proof. Heh. The next day after work, he bought another 15 pack of beer. He just wasn't done quite yet. Rock bottom loomed just 7 days away. Bobby at Lutheran hospital-September 15, 2006
Post script: when Bobby did finally quit for good, he ran in to big trouble. Not knowing anything
about the "DT's" or "the shakes" , he developed alcohol withdrawal syndrome and was hospitalized for 4 days in serious condition with Delerium Tremens, (Latin for "shaking frenzy") a potentially fatal condition resulting from rapid cessation of drinking alcohol. If you or a loved one has a drinking problem, NEVER try to quit drinking cold turkey.
Excerpt from Elsevier Health Sciences:Withdrawal from other drugs which are not sedative-hypnotics such as caffeine, cocaine, opioids, etc. do not have major medical complications, and are not life-threatening. Withdrawal reactions as a result of physical dependence on alcohol is the most dangerous and can be fatal.

Saturday, April 14, 2012

De Quervain's Pains

Educational video describing the condition known as De Quervain's Syndrome.

Sunday, December 25, 2011

Merry Christmas to all

Please click image to enlarge it and get full effect

Friday, September 23, 2011

Thursday, February 10, 2011

CELLS GONE WILD-diagnosing liver cancer

Here is a pretty good article about diagnosing Hepato Cellular Carcinoma, also known as LIVER CANCER, or Primary Liver Cancer, as apposed to secondary Liver Cancer aka liver metastases.
It seems to this liver that the techneque to diagnose these CELLS GONE WILD is as much art as it is science, and even maybe a small dose of VOODOO thrown in for good/bad measure.

Any way the LUMP being hunted and stalked by the hepatology department at CU, headed by the World Famous Hepatologist Jane Berman (name changed to protect the innocent)
is still at large, not being called an HCC and not seen clearly due to technical matters, which are detailed in the linked article. So, if you are a friend or daughter, or mother/dad, or sister or brother of the same human family as billybob belongs to, and you are curious what the hairy hell Bobby is talking about when the subject comes up, just check out the part on "washout" as far as the CT scan is concerned... Think about why Sawyer's Mommy doesn't drink from his bottle and employs the super cool bottle cap trick, to avoid washout... Liver nodules which have scar tissue, can flood with the blood which is not dyed by iodine, mixing it with dyed blood, at the precise moment they are supposed to light up like the Vegas strip, because of an auto injection of radioactive iodine, they get "washout", and they hide from the camera. It seems that this is the only time during a CT scan this could occur in the whole human body. Scarred livers have blood flowing in all kinds of crazy directions. Dual phase CT scan is supposed to take pictures of non radio active tissue and then it takes pictures of the same tissue a moment later with a shot of that iodine, to light it up all the blood vessels... but in order to see a small just forming tumor, it has to be snapped at just the right moment, and the body rides through the scanner for several seconds, moving, and by the time the camera catches the part where the suspected tumor is located, the dye may have "washed out". Portal hypertension in action. Backward blood flow.

Here is what the radiologist said about it-copied in shortened version:

The vague hypodensity bulging the capsule in the left lateral segment anteriorly, best seen on series 9 image #38 is not significantly changed. No lesion here is more conspicuous on delayed imaging suggesting possible early washout. Additionally, there is vague mottled hypodensity throughout the right lobe of the liver.
1. No change in subtle left lobe of the liver lateral segment anterior hypodensity which may have early washout. Diagnostic considerations include regenerative nodules after infarct, focal fatty infiltration, although mass cannot be excluded, given recent normal ultrasound and stability, this is felt to be less likely.

What else is there to say, lol.

Monday, November 22, 2010

Update-FOGMACHINES is now AC

Forget all the other letters in the Mnemonic word FOGMACHINES. There are two left according to a new radioiligist describing the Skeletal survey. Bombarded with a hundred zillion x rays of just about every single bone,
There was a different opinion from that of the original reporting radiologist.
This one felt that the Lytic lesion is actually a single solitary expansile lesion. Expansile lesions are not the same animal as the lytic type. The Greek word for Lytic actually means "to separate" or break down, as in destroy.
Expansile has a less scary meaning compared to lytic. Both could be bad, especially in the presence of this much pain...More important, the radiologist describes a lesion which is non agressive in appearance, in other words a well defined sclerotic border, instead of the more scary ill defined squiggly lines of a cancerous bone tumor.

The two letter which are left are

Aneurysmal bone cyst



Where we go from here, nobody knows. The only thing we do know is... OW.

Wednesday, November 10, 2010

Let's Get Mnemonic

When you see lytic bone lesion think of FOGMACHINE.

Differential Diagnosis (Mnemonic = FOGMACHINES)
F = Fibrous Dysplasia
O = Osteoblastoma
G = Giant Cell Tumour
M = Metastasis / Myeloma
A = Aneurysmal Bone Cyst
C = Chondroblastoma
H = Hyperparathyroidism(brown tumours)/ Hemangioma
I = Infection
N = Non-ossifying Fibroma
E = Eosinophilic Granuloma / Enchondroma
S = Solitary Bone Cyst

11 choices, spin that wheel, where it stops, you'll still get the bill!

Friday, November 5, 2010

Full x-ray inventory of the skeleton and a rib biopsy

Next up: there will be full x-ray inventory of the skeleton and a rib biopsy.

The plot thickens. There is a suspicious lesion on the liver. There is a suspicious hideous looking lytic lesion on the left anterolateral seventh rib, which feels like a hot nail being driven in to the hilt. This rivals the notorious bone chip in the jaw bone, hunting season 2002, after a deep root cleaning by the worlds most nazi-like dentist ( who shall remain nameless). It is certain that the hygenist broke the rim of the molar and the fragment stayed down in there between the jaw and the gums until it worked it's way out of the bottom of the gumline a month later, after many dreams about being Steve Buscemi in "Fargo"...

"They froozhen shot me!!"
Now the recurring dream is of Wade Gustafson, saying to Carl Showalter "No money, no Jean!"..."No money, no Jean!"...and then he shot Carl Showalter (Steve Bucemi) in the face after Carl shoots him in the left anterolateral seventh rib....