The good news is I don’t appear to have hepatitis. The bad news is I am still completely unsure why my liver doesn’t seem to be cooperating with the overall improvement in my health. I will reiterate this concern is derived almost completely from numbers for which a lab has decided normal values and my numbers fall outside this range. The problem is my numbers are not just a little outside the range and it is not an isolated set. My ALT and AST have been climbing now for about a month and now are about 4 times the normal high. Obviously my liver is not excited about some aspect of my current care. I would still like to maintain the belief that medications are the cause and I would like to just stop them all. Although I have had patients in the past do just this which most frequently does not elicit the “hooray” or “I told you so” moment the patient had hoped for. In fact I can’t really think of any cases where that happened but I am sure I have potentially blocked out my failings as a physician if this did occur. More often the outcome is one of catastrophic or, at minimum, moderately disturbing failure within the patients body so I have learned to at least take it slow and listen to what Dr. Liu and Seattle tell me to do. The major fear for me at this point other than hoping it is meds is the cause of the elevation is from GVHD. Although this wouldn’t be fun the hope would be that it is still controllable.
Beyond the worry of my liver the day was quite nice. I dropped off Liam and had a little early morning ski. I still have not figured out how to ski at my new pace which is far from what used to be slow pace. I often find myself thinking I feel quite well and going a bit harder (higher heart rate) than I should only to find out after about 15 minutes that I can’t recover. I spend the next hour slogging around stopping every 10 minutes to make sure I don’t pass out when I do this. I can’t wait until someday I have a relatively normal hemoglobin. My guess is I will feel like a over inebriated twenty something at a wedding. Full of oxygen, I will be unstoppable. Beautiful to all, friend to any, and full of awesome dance moves. Truthfully though I would just settle for not feeling like I may black out alone in the snow and woods (I have yet to get close to that).
After the ski I got a little smarter listening to resident presentation at a Family medicine department meeting. I spent the rest of the afternoon doing chores, getting Finn and getting dinner ready. The boys had their first night of soccer ( Liam-“not the first night ever, I have played before”). They were quite entertaining. Although Finn was far to young to be in this group I convinced them to let him in. He held his own as I think there were multiple parents pushing their childrens ages a bit higher. I was just thrilled to see them running around with giant smiles. They would have done Jim proud. I think Mark, Luke and myself would have agreed though that a little less smiling and more focus may help them. This is why Jimmy is a better coach. They had a blast though and that really is all that matters. Their effort resulted in a quick bedtime. Watching them I was often on the verge of tears. I don’t know when or if that feeling of being so lucky to see them enjoying life will ever go away. I think I would have reveled in watching them had I not got sick. Amazingly though coping with cancer has made all these little moments so much sweeter. I even remembered to tell them that just watching made my day. I hope I get to keep doing that for years.
Head Up, Heart Strong. I need a cure.