Health Matters.  I'm going to blame this entry, which may sometimes be repetitious, on some friends who suggested that I should spend more time talking about the current state of my health.  I haven't tried to avoid what it's like living with cancer.  In fact, I've tried to provide regular updates, and, both in the blog and in conversations, I try to be matter of fact about it.  I don't want to avoid the topic, but unless there's been a significant change, after a brief discussion, I'm ready to move on.  If there's nothing new to say, why say it yet again?  The constants remain constant, and there are so many variables that--and this is extremely frustrating--it's hard to assign cause-and-effect results.  It's hard to know what changes are because of specific, non-cancer related events or which are just the results of being a 67-year old who smokes and who sits too much undergoing the natural aging process.

The constants remain constant, even in their inconstancy.  How good any moment is, how much energy I have both vary from hour to hour, from day to day.  One minute I'll be congratulating myself on how good I feel, the next I'll wake up to find Mohamed taking a picture of me, mouth open, eyes shut.  One day will be generally good; the next surprisingly not so.  I've taken chemo every day for the last 18 months, so I've become inured to many of its consequences.  I know that by late morning, I'm going to fall asleep.  I know that almost every afternoon, I'll sleep deeply for two hours.  And I know that if social events, which are always energizing, are scheduled, I'll need to plan my naps.  Luckily, falling asleep is never a problem. 

Food is a trickier problem.  Most of the time, I have no appetite.  Something that tasted good yesterday is unappetizing today.  Before every lunch and every dinner, Mohamed asks what I want to eat, and too often, the answer is that nothing sounds good.  (Sushi is, as I've often written, the one exception; I can almost always make it through a plate of sushi.)  Going to a restaurant has seemed less attractive lately as well.  We run through the list of possibilities, and none of them sounds good.  We used to go out once a week for a steak dinner, but the last time, I started the steak and promptly became nauseated.  For the moment, steakhouses are off the list, which in Topeka, isn't that long to begin with.  At best, I can make it halfway through the plate (which, given American serving standards, is probably sufficient).  The servers are always asking whether there was something wrong with my meal.  At my last Med Center weigh-in, I'd lost only 10# since the beginning of all this, but, much to Mohamed's chagrin, I think I've lost more since then.  My face looked a lot fuller in pictures from a year ago than it does now.  And now that it's winter, only I can see my skinny white legs and arms.  ("They will say, how his arms and legs are growing thin.")  But the changes are, I think, not all that great.  Friends who see me regularly always say how good I look, so perhaps our concerns are somewhat overblown.

The diarrhea and nausea are the other constants.  If I took enough Imodium, it worked pretty well--not perfectly, but well enough that when the doctor asked if I had problems with incontinence, I, unlike Al Roker, could say no.  There have been some awfully close calls, however, and certainly the fear of loss of control is a major worry.  Before the insurance company would pay for the tincture of opium, I had to move from the OTC Imodium to an inexpensive prescription drug, Lomotil.  I tried that for a few weeks, and it seemed about as effective as Imodium, but during the time I had more frequent nausea.  Whether the Lomotil caused (or even increased) the nausea is unclear.  Causation is hard to prove.  For the last week, I've taken the tincture of opium, which I paid for myself ($125 for a ten-day supply), though I think, if it's effective, the oncologist can make a successful appeal to the insurance company now that I've complied with their directive to try Lomotil.  Like the other treatments, it seems to be fairly effective, but not the panacea I'd hoped for.  I got up at 6 this morning because I needed an emergency trip to the bathroom.  Twenty minutes later, I was back again.  And in the meantime--and this was a morning first--I had thrown up.  I'll stick with the tincture for a while to see how my body adjusts to it over time.  In addition to how debilitating nausea and diarrhea are physically, it's also tiring just to try to figure out (to say nothing of writing and reading about) what's working, how it's working, what its consequences are . . .  Anyway, it's fun to say I'm taking opium, though I haven't experienced any revelatory (or even banal) visions.

Sudden problems are also confusing.  A couple of weeks ago, I seem to have sprained my right wrist.  The most logical explanation is that I usually have to push myself up from the couch with my right hand (the left arm works well these days, and it doesn't cause pain, but it's not good for bearing a lot of weight) and that I had twisted or strained the wrist in one of my many pushes.  I wore a brace on my hand for a week, and now it seems fine.  But for that week in the back of my mind, there's was always lurking the fear that it was more than a sprain, that something more serious was going on. 

In general my spirits remain good, and I can always pull myself together when friends come over.  I think I'm as engaged and lively as ever.  Over the last few weeks, however, going out has often seemed more trouble than it's worth.  We went out for about 90 minutes last week--to the pharmacy (a very frequent destination), to the bank, and to a restaurant.  I ate half of my food and then rushed to the bathroom.  And then I was very happy to return to the couch or the bed.  Is this seeming lack of energy meaningful?  Or is it just that it's winter, and the short days and cold temps make a clean, well-lighted (and warm) place more attractive than they'll be in a couple of months?  Very uncharacteristically, I haven't even started a new book in a couple of weeks.  I browse through the Amazon best-sellers and personal recommendations, and nothing looks good.  I run through the list of classics that have given me pleasure in the past or that were on my to-read list, and I can't settle on anything. 

So that's the state of my health--both physical and pschologically--today.  We go back to the Med Center for the whole battery of tests of the 25th, and then I'll know more about the actual cancer rather than just the consequences of treating it.  Later today, some friends from Kansas City, who have just been to Paris, are coming in for brunch.  In addition to our having a fun conversation, the day will be even brighter because they're bringing me some authentic French food.  I requested gesiers (duck and goose gizzards preserved in fat), perhaps not the most healthful food, but something I know I'll enjoy, and since last time, Mohamed took one bite and said the rest were for me, I can look forward to devouring the entire batch.  I wanted to ask for foie gras, but since these are gifts, I didn't want to sound too greedy.  So I suggested a rabbit terrine.  My spirits have already surged at the thought of good talk and good food.