Turns out Lester was a baaad lesion. A PLASMACYTOMA

Turns out, Lester was a baaaad lesion. He was the result of an extremely rare malignant  plasma cell tumor called a Plasmacytoma.

It was a CANCER after all.
 

The phone call came around noon yesterday. It was the Highly talented and well known thoracic surgeon, and he had the report in his hand. Was this a good time? He encouraged Notbillybob to get a pen and paper and write down the words, even spelled them out for him. P-L-A-S-M-A-C-Y-T-O-M-A....
M-Y-E-L-O-M-A...

After reading about these words all day, Notbillybob finally sat down at his computer to post this on the Facebook group. There are way more questions now than answers. Multiple myloma is well known, being the second most prevalent form of   hematological malignancy in the U.S.

So, click the links. Read all about it. Remember, Notbillybob HAD a lytic lesion in his left seventh anterior (front) rib. Last Tuesday it was yanked out. He might still HAVE a multiple myloma present. "The rib tumor could be a MARKER of more disease..." said the Thoracic surgeon. Myloma usually has three major clues that it is present.
#1 Kidney failure. Well, we don't have that.
#2 high serum calcium reading. Well, we don't have that either. 
#3 Aplastic anemia. Well, no one has said for sure, but Notbillybob can read, and followed every morning blood draw while in the hospital. (They have a thing called "My Health Connection". There's even an Android app in the Play Store for it. Seriously!!) The problems plagueing him when he went in-namely low platelets, low hemoglobin, low hematocrit, low white blood cells, and low red blood cells...all point to aplastic anemia. Google search these readings all being low and the answer you get is an exquisite little inconvienince known as...
STINKFOOT! No, wait, that's a Frank Zappa song.  You get aplastic anemia. They are all low at the same time.

The Hematology and or  Oncology departments might call soon to make a follow up appointment.

Here is a short list of the recent ailments Notbillybob sought medical treatment for, which are directly related to this cancer.

Dequervain's syndrom of the wrist    - related

Dry eyes                  -related

headaches            -related

fatigue-related

shortness of breath     -related

nausea                -related

Dizzyness causing falls     -related

Severe drop in platelets thought to be liver related-now believed to be related to plasmacytoma.

Petchae/purpura rash      -related


Who'd uh thunk, huh? Well, off they go back to the U this rainy morning. The chest tube dressing is draining, so they want to see him.

Not the twilight zone, but rather... LIVERLAND

 

He gives one last high five  as he spins out of the room. Already his name is lost in the oblivion that is called LIVERLAND. He worked the night shift last night here at the "U".
Notbillybob and he jawed all night long abut the old days, and San Diego, a daughter born at Balboa Naval hospital, and small ships and "The good ol Navy" from the 32nd street Navy base to North Island Naval air station,  to last but definitely NOT least, THE Naval Training Center on Rosecrans, as seen in the Tom Cruise movie Top Gun. 
This nurse  had been stationed on board a 7th fleet fast frigate called the USS Meyercord FF 1058. 

He was an OS2, or operation specialist second class petty officer. Just like Phil. Ops. Operations. An Ops guy.

 Before the night shift came on, Notbillybob Choked back the sadness when things didn't go well during the Platelet/ Warfarin teeter totter that everyone took turns on yesterday. Bood is clotting too slow. Now too fast. Now to slow. OOPS, again too fast! Toot Toot understands all too well... this up and down ride. So does Ma.  Mas' is related to blood sugar.

Toots is related to INR. Clotting time. They wanted his clotting time to be plenty fast so that when they took out his chest tube, there would be minimal bleeding, if any.  When the platelets finally arrived, the nurse was bummed. They just weren't going in fast enough. They were burning daylight. Past noon now. The plan for going home was fading... into the amoniated haze of LIVERLAND.  

LIVERLAND is a place where computers  revert back to Windows 98 machines, where there is no cruise control, or frequent flyer miles. 

There are no cell phones in liverland. Mobiles, yes, but like the big ol brick from Miami Vice. Hold the pickles hold the lettuce will upset us, Hell no ,no,no,no
You cannot have it your way in LIVERLAND, 

and if you want to flirt with the girl two rows ahead of you in your Biology class, you're going to have to do it by passing a note just like the rest of us. 
Speech is slurred, keys get lost, I mean really lost. You might show up for a doctors appointment which was a real bitch to get in the first place. They put you on standby, and called you last week to tell you there was an opening, and did you want it. Only to be told now that you had missed by a day. Yesterday the doctor had clinic. Today he is in surgeries all day, I'm sorry. And no, we cannot do anything about the fee, sorry.




And if you want to go home lickity split from your super-major chest wall operation to remove a severely diseased, crushed from inside rib bone from the anterior left costal area under notbillybob's armpit, 

you gotta get there by taking the normal path, the unbeaten one. 
 The one where the labs are normal, or somewhat normal,
The one which doesn't go straight through the middle of this oozy, wierd slow lane.

He's Home, now. Yesterday, they opened his cage, and let him fly away. There are after care orders, and one stitch to remove in follow up clinic. Go figure, they ripped out a chicken leg size hunk from the chest wall, and just  glued it back together, placed some steri strips, and wa la!

 Be on your way young man. The biopsy report is pending. & to 10 days out. It was sent to Johns Hopkins pathology lab. Or so they hope. 

Click on the image for the cool Panorama effect

From CU hospital-THE TASTE originally posted by Billybob September 1, 2008

Good Morning from THE "U" !


Let's go retro...

Peoples, it.s time to go a little retro...
a lot of folks might remember a different cousin Bobby, uncle Bob, or nephew John Robert, etc, one with a can of Budwieser in his hand at all times. Drinking beer from a straw out of a pitcher up at Shamus Otoole's roadhouse salloon in Breckenridge Colorado, or even sometimes having a cold one for breakfast on rare ocassions, like fishing trips, Tipi camping, Mountain man rondevous, etc.
This is no lecture, or stern warning, or feel sorry  post. Nothing of the sort. Just a simple explanation of why you never see him without this giant hospital cup, maybe with a coin on a keychain dangling. Why he never makes it up on the annual camping trip, despite being retired since 2006.

See, they gave him the cup in the detox facility at Lutheran inpatient behavorial health-West Pines. He was humilated to be admitted there, even though it was totally voluntary. He told no one that he was there. Hid it from the family. He figured that this cup was the key. He would drink ICE WATER, now.
From his detox cup. Kind of like a wubby, or binky. Sippy cup. (super big gulps were always the drink of choice when beer wasnt being served, anyway. In the detox, he would fill it with Hawaiian punch, and take it to group with him. They let him smoke in there. Can you believe it?  Somehow, the cup was a great comfort.
Because of her brain condition, Sharon drops things.  She dropped the CUP. Cracked the edge pretty bad. . It was a total disaster. Sure it still worked. But it was all cracked now. So,  back to the detox we go. A nurse agrees to meet us outsde. But it's a lock and key facility.
Only one way in, and it ain't good one. They got a brand new whirly hospital cup waiting.
Sharon explains the whole story to the nurse. The nurse quickly returned with a brand new one in a sealed bag. Sharon thanked her profusely -"Honey if it'll keep him sober, go right ahead. " was the reply. Weeks earlier in the emergency room at CU hospital , doctors had told him he needed to quit drinking, that he had alcoholic hepatitis. Inflamation in the liver from drinking to much beer. They just forgot to tell him how to quit SAFELY. I know what you're thinking...But  dont worry, all you heavy beer drinkers out there. The American liver foundation puts the number at only between 10 and twenty percent.

From thier own website-

"Alcoholic cirrhosis
Alcoholic cirrhosis is the scarring of the liver -- hard scar tissue replaces soft healthy tissue. It is

the most serious type of alcohol-related liver disease. Symptoms of cirrhosis are similar to those

of alcoholic hepatitis. Between 10 and 20 percent of heavy drinkers develop cirrhosis. The

damage from cirrhosis cannot be reversed and can cause liver failure. Not drinking alcohol can

help prevent further damage. "

So,that's like one or two guys out ten at the PARTY. Gonna get a baaaad biopsy report one day. Then a nightmare begins. Like a roller coaster you can't stop. You gotta hold on tight, and not
fall off.
The old CUP has been replaced dozens of times. The original is enshrined at el Rancho de Aragon, on a kitchen shelf. They can be bought on EBAY, 3 for 20.00 , sometimes much much better than that. Especially when you are married to the queen of EBAY auctions, she'll sneak on in there and outbid you with 5 seconds left every time. The Whirly drink works, Warren Pennsylvania, family owned and operated for over 50 years. Get yours today. Hopefully on EBAY, not West pines. 
This was just the intro to the retro. Here goes the retro-
THE TASTE- by Billybob September 1, 2008
On the Sunday morning of 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.

A tornado of white lab coats and green scrubs

Day 1 Rounds.
Today begins with a whirling dervish of learned Fellows, interns, residents and surgical nurses,
 You have to have bullet point questions ready. You have to be ready for the answers.
 Write it all down, n shrthnd as fst as u cn.
They fly in, plant thier feet and put thier eyes on you

handshakes, no don't get up... lol.

The output on the chest tube is slowing better than expected. Probably it wont
come out today. But lookin good. Incision looks good. I'm looking good. Pain is BAD but, a different kind of BAD. Like having part of a rib removed and a long rubber hosed inserted into the space between the ribs and lungs. Pleural. Or is it Plural? LOL.
I think people say I look good because a low protein diet caused my hair to straighten... 
I love it.
 I always say "I make terminal liver disease look good."I could be The poster child.
Still we are curious why the blood work went so badly leading up to the surgery. Could  there be a transplant evaluation in the future as a result? Was the tumor pushing on mister spleen Mcqueen and causing him to destroy platelets?  Platelets are like money.
There are two ways to have low platelets- 1-don't
 make enough, or 2-they get destroyed by the spleen which is trying to keep house.

Destroyed, spent... same thing. Like a bank account. Low. NSF. Don't want a check to

BOUNCE.
Good morning WORLD. can you tell that I am grateful to be awake, breathing-(painfully though) 
 Alive. Largely because of the Greatest Team on Earth here at the "U"'.
Doctors....Interns... residents, Fellows, AND
nurses, Some of the COOLEST nurses I ever met.

Whirling all around.

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. 

                                                       

Fiftysix-

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".

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