shouldn’t it just be, “requires a warrant?”
with updates less frequently than halley’s comet (how ’bout that dated reference), i’ve left a couple people wondering if i’m still alive. yes, i’m still alive.
while this blog ended up chronicling my reflux/barrett’s, that’s not really the life i live day-to-day. to assuage any concerns: my scope and biopsies came back with a reduction in inflammation (expected) and no increase in either surface area or severity of the dysplasia (good). a few estranged acquaintances reached out and asked if i was ok… i finally realized it was driven primarily by my last blog post. so… yes, i’m still alive.
i’ll make a half-hearted attempt at another update sometime in the near future.
i’m impatient. generally, but also in this specific case: i hate waiting for pathology reports. my gastroenterologist took (his words) “lots and lots of biopsies,” this morning and expects them to be back from pathology in 2-4 weeks.
quick update on the scope: this is my nth scope, where n represents “lots and lots.” (10? 15?) i knew what i was expecting. of course it still makes me nervous and of course when they first push the drugs into the iv it surprises me. the pain meds wore off about 4pm and my chest hurts a little. i won’t know anything concrete on the barrett’s esophagus until the pathology reports come back, but my doc did double up my meds based on the visual inspection. he said it was clear that more proton pump inhibitors would help. he also (before i went under) said that he’d like me to schedule a follow-up to discuss treatment options. note that this is the doc that preferred the ‘watchful waiting’ approach (which is the american medical associations defined standard of care for low grade dysplasia). he told me to read up and come with questions if i had them.
i’d love to get the slides back from pathology, but my doc doesn’t even get that. no, i don’t think i could do a better job than someone who does this for a living; i’m curious! it’s probably significantly weirder than asking a dentist if you can keep the tooth they pull. “can i keep my biopsies”?
johns hopkins did a study on the consistency (since accuracy isn’t possible with a subjective grading of samples) amongst pathologists and found that some samples commonly have large variability between individuals. 12 pathologists saw 24 individual samples twice (without knowing which they’d already seen). most pathologists were “internally consistent” and graded the same sample the same way both times. some samples had variation from “low grade dysplasia” all the way to “high grade dysplasia”, depending on the pathologist. i can’t find the original study, but they’ve published some guidance for pathologists based on that study.
in a few days, i’ll get a full color glossy print-out from my scope (yes, ew) with some notes scribbled up to reflect the conversation i had with the doc. they don’t expect you to remember much, since the versed, thankfully, has a side effect that gives you amnesia.
i’ll post an update when i get that.
i’m scheduled to get an esophageal scope on monday. the only appointment they had was at 8am, in the fremont district of seattle. getting to fremont by 8 means waking up at 5am or so. i expect to be fully comatose for the balance of the day.
yes, it really has been well over a year since i posted. the irony of having a life that is full and rewarding is that i infrequently have time to (publicly) reflect upon it.
a friend of mine one suggested a rule to determine when you might consider not taking a risk. the basic rule (paraphrased) is:
if you would be embarrassed describing how you got hurt to the medical personnel treating you, you should seriously reconsider your actions.
last night, i conspired to violate the hospital rule: with a straight faces, a colleague suggested that he climb a step ladder, onto his roof (steep pitched, metal, and covered with snow), and fire roman candles.
it seemed like a perfectly reasonable solution to the problem we faced and i agreed to climb up on mine with the cordless phone and binoculars. his wife vetoed and unknowingly invoked the hospital rule. probably best; explaining how he got the burns and broken bones in the same accident might have… well… violated the hospital rule.
two months ago, i had a consultation with a new gastroenterologist. i was due for an upper gi scope and decided to stop putting it off. having moved a year ago, i didn’t have a gi in this area. i found him through swedish medical and the barrx (or bârrx) directory of practitioners who’ve licensed the technology. i scheduled an appointment. he’s based in seattle on first hill, in a building that adjoins a swedish medical facility. when the mid-day appointment arrived, i drove into seattle and found the building and office remarkably easily.
after the typical new patient foreplay… filling out forms, blood pressure, heart rate, etc., i spent 45 minutes talking to my new gastroenterologist. he was very well read on barrett’s esophagus and 80% of his practice is treating the condition. i’d intentionally used medical terms (“7cm segment of intestinal metaplasia with no dysplasia observed” instead of “i have barrett’s”), when completing the forms, to avoid being talked down to. it’s incredibly frustrating to have to explain that you don’t need an explanation.
after a minute or two of gauging my knowledge and interest, we discussed bârrx (he prefers “halo”, as bârrx medical is the name of the company while “halo90″ “halo360″ are the names of the procedures/products). note that i’ve been putting off this surgery for some time now. immediately following my diagnosis, i made up my mind that this was a course of treatment i wanted to pursue. he explained that treatment of barrett’s patients who have no or low grade dysplasia isn’t something he does often. he explained his reasoning behind it. he quoted some much lower figures than i’d heard, for the probability of developing an invasive carcinoma, in any given year. i explained why i was still interested, despite the fact that it’s not the american medical association’s ‘standard of care.’ he seemed to understand and said, “let’s just get a scope and talk after that.” fair enough, so back in the lobby, i made a date with a camera on a stick.
being treated like an educated adult by an educated adult, in this circumstance makes all the difference. i learned a ton, felt like my opinion mattered, and came out if the conversation with a degree of trust for my new doc. did i mention that a doctor spent 45 minutes in a consultation?
the process of prepping for an “egd” (short for: esophagogastroduodenoscopy – best word ever) is pretty simplistic and the instructions on the photocopied sheet they hand you fall into a few areas:
- keep your stomach empty (no food or drink for ~8 hours beforehand)
- don’t mess with your body’s ability to heal wounds (no blood-thinners or anticoagulants including aspirin)
- before you start fasting, don’t eat anything that would confuse the doctor (mostly this is defined as “no purple or red staining foods”. the examples they give are red jello and kool-aid.)
no problem, right? these are easily followed directions, right? only a moron could screw this up, right?
went out for dinner the night before. spur of the moment, we went to the barking frog in woodinville. great menu and it just seemed like the right thing to do that night and with my appointment mid-morning, leaving 8 hours between food and scope was going to be easy. the place was pretty empty, even for a thursday night, so we managed a small table near the fireplace. we enjoyed the meal so much that a couple at the table next to us literally said, “we’ll have what they have.”
their menu is always great; i had:
Seared Hudson Valley Foie Gras
House Made Beignet, Strawberry ~ Vanilla Drizzle
Baby Beets & Arugula
Laura Chenel Chèvre Crottin, Aged Sherry Vinaigrette
Wild King Salmon
Pan Fried Tomatoes, Cucumber & Dill Créme Fraîche,
Roasted Romanesco Broccoli with Dry Aged Jack & Roasted Poblano Cheese Fondue
amazing meal, but see any problems with it? i had a minor freakout, when i realized that the (quite tasty) beets quite easily met the “red or purple foods that might stain your insides” criteria. a call to the surgery center in the morning assured me it was not the crisis i’d imagined, mostly because my appointment was mid-morning.
the scope was uneventful. the drugs are great. after spraying your throat with lidocaine, a healthy dose of versed is pushed through the iv catheter. in addition to the euphoric “please shove that 4 foot long hose down my throat, i won’t mind” state it leaves you in, it has the tremendous side effect of partial amnesia. apparently i insisted that i needed a bagel sandwich, on the way home… don’t remember it. as with my past scopes, i slept for the rest of the day.
got the results in the mail, a couple weeks ago. along with a fairly graphic image of my food tubes, a brief and barely legible note that reads “10cm segment no dysplasia some ulceration sched. followup.”
given that, the punchline is that the segment has grown some (30%) in the past 24 months, i don’t have dysplasia (more significant probability of developing cancer), and the symptoms of my reflux/gerds are not completely controlled.
i’ll likely schedule a follow-up appointment for the week after new year’s.
i submitted this, as a “medical inquiry”, early this morning:
I was thrilled to catch one of your commercials on television the other night. The URL “silenceyourrooster.com” displayed at the end told me that your product might fulfill a need in my life. In examining the collateral provided at silenceyourrooster.com, I’m unsure how to proceed with getting Ambien CR for my rooster.
My rooster is a 7 month old Buff Orpington with traditional markings. He has recently started persistent crowing from sunrise until 9AM or so. While we find his crowing amusing and live in a rural/agricultural area, we have neighbors within earshot of his usual pasture. If Ambien CR can actually (temporarily) silence my rooster, I believe it might be the perfect product for this situation.
Please advise on how I might get Ambien CR prescribed for my rooster?
i’m a geek.
i can geek out on almost anything. in trying to figure out how i’m going to structure the work my team will do over the next year, i did a fair amount of research on the topic of “innovation”. i totally geeked out on it, and came out the other side feeling dumber for my efforts. connceptually, it seemed a little odd to research “innovation”. in my mind, research is an attempt to uncover “prior art” (what other people have done), while innovation is all about the forward looking and the “radical departure from status quo.”
having said that, i really really really like talking to people who have a novel approach to solving an old/common problem or a clever application of a new technology and want to give my team some space to do that. i have some ideas about how i might acheive this, but wanted to back them with “measurable goals”.
the earth-shattering outcome of my research? i’ll save you the frustration and brain damage:
- i’m really glad i’m not the director of it for some small company.
- lots of people think their reuse of something clever someone else did is “innovative”.
- “innovation” is a good way to explain something that you spent a bunch of time on that still hasn’t paid off.
- people who do innovative work don’t generally use the word in a sentence without “air quotes”.
- and… the only thing i’ll retain… there are two approaches to innovation, supply driven and demand led. (more in the following paragraph)
two simple thoughts:
supply-driven innovation occurs when you have a new technology looking for a problem. (“oh, look! new hammer! where nail?”)
demand-led innovaiton occurs when you have a problem looking for a solution. (“pile of nails and i got nothing heavy.”)
yep. that’s it.
it’s not much, but it’s what i took from three hours of reading papers on innovation, metrics to evaluate the impact of innovation, and a fair amount of meaningless drivel.
side note: in the right light diana krall sounds an awful lot like queen latifah. (see also: various artists: we all love ella: celebrating the first lady of song)
this is my 100th post to bengt.org. based on some pretty weak apache log analysis, i estimate that roughly 165 people will read this over the next year. i apologize in advance.
i haven’t posted for months, but endeavor to do so more.
i’ve returned from a great vacation and despite feeling alternately tired and overwhelmed by the flu-like symptoms, i’m pretty optimistic about my life. ;)
a few quick updates:
- i’m procrastinating the surgery but have been managing my diet closely. symptom-free for the most part.
- my kids are now 7 and 3. i feel old, in this context.
- work is going well. i’m frequently reminded of how kick ass my team is. makes my job easy.
i might even post again, later tonight, but figured it was worth getting something out there, even if i don’t.
i contacted the thompson center, after procrastinating for a couple months. dr. overholt is out until march 20th, but i will likely have my surgery the last week in march.
i’m nervous, but optimistic about getting through this phase of the treatment.
i’ve almost entirely lost my voice, today. horrible cough, too. i’m tired of being sick.