Billy Bob's Wild Ride: Not the twilight zone, but rather... LIVERLAND

Sunday, July 27, 2014

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

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Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)