Health Update, 29 July, 2017

Sorry for the delayed entry.  Since my ½ dose treatment of Chemo on July 12th, I was really doing well, having more energy and good appetite, played three rounds of golf in two weeks.  But on Monday the 24th, I started having shivering and chills even though in the Pacific NW we were experiencing a heat wave.  I got under the electric blanket and couldn’t warm up for at least two hours.  Tuesday morning the chills subsided but I was somewhat confused.  In my state of bewilderment, I mistakenly took two of my regular B/P pills.  My B/P dropped to as low as 60/40 but very slowly returned to normal levels by bed time Tuesday.  Linnea was in Portland attending to her mother’s affairs, since she passed away on Sunday the 23rd.  Luann Enz was an energetic pioneer during her time, having graduated from Willamette University when most women did not pursue higher education.  She was tolerant and always expounded equality among all people and civil rights as human rights and everyone deserves dignity.  She had been a vital part in the lives of many people she encountered, and certainly amongst her immediate family.  We will all miss Luann Enz.  I had not gone down to be with Linnea during Luann’s final days because my mother Shirley had L total hip replacement surgery on July 17th.  Her post-op course has been complicated with massive repeated hemorrhages.  (Another saga.)  Linnea rushed back on the 25th to care for me since I was scheduled for Chemo on the 26th.

Prior to treatment the lab report indicated my White cell count had returned to normal of around 7000 however, it also showed elevated liver functions.  Dr. Picozzi suspected a bile duct obstruction and ordered me to have a CT scan instead of proceeding with Chemo.  I had the CT scan late, around 5:30, and the formal radiologic report wouldn’t be submitted until morning, thus we came home.

That evening, I started a having a fever, rising up to 103+!  Linnea called VM at 1:00 am Thursday and happened to get Dr. Picozzi who wanted me to go to the VM ER on the next ferry which was 4:45 am.  We did and I was seen by the ER doctor very promptly.  They did blood cultures and admitted me for endoscopic exploration of my bile duct because the previously performed CT scan showed engorged bile duct with nonspecific obstruction.  An ERCP was performed placing me as high priority even though the GI procedural schedule was full for the day.  Indeed an obstruction was identified and a stent was placed.  I was hospitalized for sepsis, antibiotic treatment and observation.  I did well and was discharged today on oral antibiotics for twelve days.  No Chemo until off antibiotics.

This is just as well because Monday we were scheduled to go back to Portland to meet Linnea’s distant cousin Anita and her husband.  Tuesday we will witness the burial of Linnea’s Mom at Willamette National Cemetery in Portland to be with her Dad because Rev. Enz was a retired Army Chaplain.  (Her memorial service is August 13th.)  On Wednesday we pick up Uncle John and Auntie May for a very brief visit before we fly to Springfield OH for my 55th HS reunion which has been a goal of mine.  I am eager to see these classmates who have been so supportive along my medical journey.

Thanks for reading.  Keep sending good vibes and thoughts.

Health update 12 July, 2017

Today’s appointment was 1:20 for blood draw, 3:00 to see Dr. Picozzi and decision on Chemotherapy.  We arrived for our visit on time and the staff was punctual as always.  My studies are improving with blood protein and albumin both just O.1 units below normal.  (I no longer have pedal edema anymore.) However, the total White cell count today was 3700 with the polymorphoneuclear leukocytes numbered only 960.  (Usual cut-off for d/c treatment is 1000.)  Being so close to the borderline, I was offered a choice of skipping a week or go ½ dosage and continue our current schedule.  I elected to go ½ dosage today; partly to have continued Chemo coverage and partly because our busy family plans were all based on the current regimen baring extraordinary changes.  The cancer marker, CA 19-9 reduced from 43.7 to 41.7.  (>37 is normal.)  This is most likely an insignificant difference, but nonetheless it is heading towards the right direction!

I was hoping that they’d use the same concentration, with ½ dose, so the volume would be reduced and the time for infusion would also be halved.  No such luck; the concentration was reduced but the volume of fluid for infusion was kept the same and the two hour flow rate was also maintained  the same.  We finished at 6:30.

Since having missed the 6:30 sailing, Linnea and I enjoyed a leisurely dinner salad at Primo’s by the hospital and returned on the 8:10 ferry.

The pre-infusion meds given me along with the adventures of the day made me very sleepy.  I am signing off now.  Thanks heartily for visiting.  Appreciate all of you and all your prayers and your good thoughts and wishes coming my way daily..

Yesterday was history.

Tomorrow is Mystery.

Today is a Present.

Starting Private Practice in Kitsap County

Previously, I left off that I resigned from the USPHS and started private practice in Kitsap County on 1 July of 1979.  To be sure, this was neither an easy decision nor one made in haste.  I was offered a position with Virginia Mason Clinic but that meant I’d have to move to Seattle to be within 30 minutes for on-call emergencies.  It was appealing to be salaried and have a dependable income, but nonetheless, I elected to try going on my own.

Prior to leaving the USPHS, on January 1, 1979, I arranged with Dr. Thomas Case at the North Kitsap Medical Complex to take all afterhours calls and work every Saturday mornings for six months as a trial.  It was rewarding in many respects including keeping 50% of all my billings.  It kept me busy and exposed me to many new patients.  Thus when I embarked into private practice on July 1st, I’d had some experience already.  However, going full time did not come easily.  Although I was seeing all the overflows from Tom’s practice (about 20% of the total patient volume) per our agreement formula I was paying 45% of the overall office overhead expenses, including the salaries of all our staff.  I was subsidizing my financial obligations from personal savings to be working full time!  Fortunately I had a little ‘nest egg’ to rely upon.  This situation lasted for quite some time, but somehow we survived.