Stem Cell Collection

In preparation for autologous blood stem cell transplant after 2024, I had my red blood stem cells harvested. The procedure was successful and that is the bottom line. That final tally was the result of very many debits and credits. Even though we had this planned months ago, when I was wheeled from the transplant clinic to the main hospital to be taken to radiology for the placement of a catheter, the main desk asked if I was a walk-in. It took them a couple of hours to find a file folder with papers that then were entered into a computer file. That was just one event.

 

I went to the Sarah Cannon Clinic at Methodist Hospital in San Antonio about 68 miles from home because the Sarah Cannon Clinic at St. David’s Hospital in Austin about 18 miles away will not harvest and store. At Methodist they were proud to tell me that they store stem cells for the other clinic. I do not know why that treatment was denied to me in Austin but it was. “We do not harvest and store. If we harvest, we use them.” So, we scheduled treatment down the road. 

 

I met Methodist Hospital last year, after my initial diagnosis because the arithmetic of chance favors the second opinion. I have been happy to be treated here in Kyle because the office of Texas Oncology here is a short walk through a city park. It is very convenient. Even so, the second opinion has been helpful. (See “The Monty Hall Problem” on Wikipedia and elsewhere.) It validated the treatment regimens and provided additional insights. So, I have been back half a dozen times for lab tests and consultations. 

All along, I have taken as much charge of my treatment as I have bandwidth for. I bought textbooks and a microscope just for orientation because I never paid much attention to life sciences. I got a book from the UT library on oncology nursing just to read twenty pages on myeloma and Revlamid® (lenalidomide). You really have to ask the right questions to get any answer and many doctors control the flow of information according to their own standards. My primary oncologist assured me that this will not require chemotherapy and we will do it with monoclonal antibodies. He sounded like Dr. McCoy. Well, it is chemotherapy; I just don’t lose my hair (yet). And right now the FDA approves monoclonal antibodies only when two other courses have failed. So, OK, I got over that last year.

 

This time, the sugar coating was on the collection catheter, a Quinton line. I should have looked it up. “Oh, we’re just going to put a tube in your neck to collect blood...” In my neck, indeed, it went into my jugular and down to my superior vena cava. That much was fine, after all. It took two imaging systems (CT and fluoroscope) and an MD to place it. (I enjoyed listening to him cluck as he drove the twisty turny lane. I knew that he could do it.) “So,” I asked, “they can just take this out at the clinic?” Oh, yes, I was assured, after they remove it, they just hold the place shut for five minutes. Well, it was ten minutes and 30 minutes no talking lying flat to make sure that it is not bleeding out and I have dressings to wear for 72 hours and I cannot lift more than five pounds. All of which is going to impact my first day of work on a new job Monday. Who knew? 

All in all, there are worse outcomes. I am reminded of a comedian I saw on a late night show who told of a woman seated next to him on an airliner, on a telephone, telling her friend about having “the worst day of my life” while reclining in a cushioned couch at 38,000 feet, traveling 80% the speed of sound. 

 

My daughter reminded me of Adm. William H. McRaven’s parable of the sugar cookie. (See "Make Your Bed.") Other people tell it differently but for McRaven the point was that being chosen to be hosed down and rolled in the sand and spending the rest of the day covered like a sugar cookie has nothing to do with any choice you made. You could not have seen it coming and you could not have avoided it. It just happened to you. Sometimes, life is like that. So, get over it.

 

And on the assets side, every one of the nurses and assistants who were my direct caregivers were capable, informative, engaging, and supportive. I enjoyed talking to all of them. Not only do I like talking about myself but I am pretty good at interviewing and I ask a lot of questions. One of my radiologists was injured in college sports and went back for a second degree. One of the consulting oncologists was a Navy doctor. I had at least a dozen great interactions over the past three months.  

  

I have been told that there are many ways to view multiple myeloma. “This is not like breast cancer. You don’t have a lot of options here. This thing is just going to run its course.” On the other hand: “Think of it like diabetes: just something you have to manage for the rest of your life.” When I was diagnosed my initial research warned me that almost half of patients have an expected end-of-life of less than one year. It is also true that the other half, 52% or more, live ten years and more. The statistical tail on the right is getting longer. 

 

PREVIOUSLY ON NECESSARY FACTS

 

Microscopy (Again) 

A New Microscope 

How Do You Make God Laugh?

Epigenetics 

Disruptive Diagnostics and the Business of Science

 

Invictus

I learned the poem in seventh grade English. The our teacher, Mr. Hart, said that he held a thesis that it was actually translated from Latin and originated with Marcus Aurelius Antoninus and that name was also attached to the poem as it appeared on the blackboard. I never found any support for the claim, though the sentiment is clearly aligned to the philosophy of the emperor, philosopher, and soldier who was portrayed by Sir Alec Guiness in Decline and Fall of the Roman Empire. 

 

“Invictus” by William Ernest Henley

 

Out of the night that covers me,

Black as the Pit from pole to pole,

I thank whatever gods may be

For my unconquerable soul.

 

In the fell clutch of circumstance

I have not winced nor cried aloud.

Under the bludgeonings of chance

My head is bloody, but unbowed.

 

Beyond this place of wrath and tears

Looms but the horror of the shade,

And yet the menace of the years

Finds, and shall find me, unafraid.

 

It matters not how strait the gate,

How charged with punishments the scroll,

I am the master of my fate;

I am the captain of my soul.

 

Previously on NecessaryFacts

The Cure for a Failing Empire 

The Influence of Ayn Rand's Objectivism 

The Scientific Method

The Scientific Method (revisited)  

Mortality 

Microscopy

 I took up a new hobby. I bought microscopes from ShopGoodwill.com and some prepared slides from Amazon. I was happy to be able to take some pictures with my cellphone using my Celestron NexYZ adapter. The first foray was easier and more rewarding than my attempts at astrophotography. In both fields, my primary interest is in verifying for myself what I read in books. I also benefit from the discovery or revelation of facts not perceived in daily life.

Based on my experience in astronomy, I sought to avoid early mistakes by finding a discussion board that I could rely on and participate in. The astronomy board Cloudy Nights has a forum for microscopy, "Cloudy Days." There, I found a recommendation for Oliver Kim's Microbe Hunter website (here), YouTube videos, and discussion board (forum). 

Kim has an MSc in microbiology and teaches high school biology. I found his narratives interesting, informative, and objective. Some others have complained that he is salesman for his favorite brands. I have not found that so. He does insist that quality and price are on curves and that the average person can find a good-enough microscope for a few hundred dollars or less. I found these two for under $75 each with shipping and handling. (I searched for 1-cent shipping and Buy Now versus bidding.) I still hold to my longterm goal of buying a Zeiss university classroom instrument for about $1000 when the time comes for me to upgrade. That will depend on my learning curve.

I also bought books, of course. I have an instructor's edition for a survey class in microbiology, a couple of lab manuals, and two handbooks on microscopes. 

Onion rind

Picking up where I left off 60 years ago, I found vegetables a lot easier to work with. The sets of prepared slides were not expensive and for that reason were also not carefully prepared. I am not big on bugs, but I could do (and have done) a better job. The specimens are mashed and tangled. So, the next step will be to buy slides, slips, and mounting fluid. (I confess to being a little shakier now than I was at 12 years of age and I think that I can focus past the intentional tremor.) 

Ultimately, I will be exploring histology for anatomy and physiology. As attractive as plants are, they do not tell me much about myself. 

I do appreciate the unity of life. One of the prepared slides is "Lily Ovary." Miss Lily's ovary speaks to the astounding multifarious expressions in complicated matter since the invention of sexual dimorphism. A science fiction story could consider a watery world in which all of the single cells share communication and thereby constitute a self-aware intelligence. The extent to which the cloned daughters would vary could be a plot element if not the story line. How is difference perceived--and is it accepted--when just about everyone is almost exactly alike? 

BAMBOO

Be that as it may, in the mean time, my new toys need cleaning. I have Zeiss fluid and other tools. However, I hesitate to disassemble the oculars and objectives. When I started in astronomy, I had a Celestron 130-mm (4.25-inch) Newtonian reflector. It came with a 20-mm and a 10-mm oculars. A little later, I bought the Celestron Lens-and-Filter Kit that I saw several others with at my first star party. I could not get a filter to screw into the bottom of the 20-mm, so I unscrewed the top--and was rewarded with a handful of small glass lenses. Fortunately, it is a known problem and Celestron has a page on their website on how to put it back together. But it was never the same. I got the faces right, but the axial rotation was off. They are supposed to be circles, of course, but at that level, they are not perfect circles and a little bit makes a difference. So, I have to decide whether and to what extend I want to pay for the lessons being presented here. 

That also impacts another toy, truly a toy, an Educsope. It cost less than $15 from Goodwill and came with a kit of tools and slides. But the stage will not stay up. From an old Tasco microscope set that a neighbor gave me some years ago, I already know this to be a problem with cheap microscopes that kids use. I can take it apart easily. Whether I can clean and tighten the rack and pinion is another question entirely. I actually did that with the Tasco. It works better now. The Eduscope is all plastic and does not hold much promise.

Previously on Necessary Facts

Epigenetics

Bob Swanson and Genentech

Biohackers

Biobash: Chamber Replicates Success

Aging in America: Alternatives to Government Policies

The first Boston Marathon measured 24.5 miles. “On April 19, 1897, John J. McDermott of New York, emerged from a 15-member starting field and captured the first B.A.A. Marathon in 2:55:10.” In 2006, that mark would place him 5th among the women age 40-49 (Gina M. McGee, 2:55:03). However, the modern race is longer. Therefore, today, McDermott would beat all of the women 50-59, but none of the women 40-49. His time calculated for the longer course would be the same as John Smallwood, in the Men’s Age 60-69 who clocked 3:10:44. 
(This post is based on a term paper for an undergraduate class in Social Problems, Winter 2008.)

May 1970

Standard textbooks for classes in sociology present aging in generally the same ways that they present racism, war, and poverty. However, by studying discrimination, inequality, stratification, poverty, war, and other problems, we are supposed to be prepared to deal with them, perhaps to solve them forever.  

And so the old joke goes Q:  How many sociologists does it take to change a light bulb? A:  The light bulb does not need changing.  It is society that needs to be changed.   
Sociologists portray people above some arbitrary age as a disabled minority, needful of government programs.  Solutions for individuals are not in the toolset of sociologists. After, all it is society that needs to be changed.  The objective truth is that aging is not inevitable. 

“The Need for Reforms” is a section subhead in the chapter on “Aging in a Youth Oriented Society” in Hardert et al. Confronting Social Problems (West Publishing, 1984). The book says: “Government officials have been aware of the special needs of our older population for some time.  … Federal programs have proliferated…” and it lists some of the many, citing a total of 48 major federal programs (pp 118-119):

• The Administration on Aging, Department of Health and Human Services
• Comprehensive Older Americans Act of 1965
• Comprehensive Older American Act Amendments of 1978
• Social Security Administration
• Medicaid and Medicare
• Supplemental Security Income
• Healthcare Financing Administration

The authors recommend volunteering for work as one solution to social isolation. “Activity theory encourages volunteerism among the elderly replacing lost work roles [paid] with unpaid involvement.” (page 120)  Certainly, under normal conditions volunteering is the noblesse oblige of the wealthy. But unpaid labor is the very definition of slavery.

Rochelle Jones (The Other Generation: The New Power of Older People) equates the government with the economy:  “… the economic ‘pie’ is limited.  To say yes to expand or improve programs for older Americans is to say no to the needs of other sectors of the economy.”  (page 121)  It is true that government funding is limited, but the fact ist that under socialism, they divide the pie fairly, but under capitalism we bake more pies. (Actually, we bake a lot of alternatives and you are free to choose.) 

 John Macionis is perhaps the leading author of college textbooks for sociology in the USA.  (Globally, it is Sir Anthony Giddens.)  Discussing “Aging and Inequality” in Social Problems  (Pearson Prentice-Hall. 2002) Macionis says (page 120) that we have gone from the gerontocracy of preindustrial societies to “the elderly as a social problem” in industrial societies.  According to Macionis, capitalism devalues those who cannot contribute labor so the old are a cost burden.  A socialist society would care for the elderly as it cares for all of its citizens.  (pp138-139).  This ignores both Lenin and Saint Paul who alike decreed that he who does not work shall not eat.  In The Ascent of Man, Jacob Bronowski tells of the Bakhtiari of southwest Iran who abandon their old when they move their herds.  In the utopian (or dystopian) novels Brave New World by Aldous Huxley and This Perfect Day by Ira Levin, people end their lives at age sixty by order. 


May 2008



In Stanley D. Eitzen and Maxine Baca Zinn Social Problems (4th ed, Allyn and Bacon, 1989), the authors offer this (page 297): “The thesis of this chapter is that old eople constitute a minority group in our youth-worshipping society, with a high visible trait – an aged body – that makes them different from the majority.  They are relatively powerless.  Their behavior and traits are stereotyped and regularly depreciated and devalued by the dominant group.  And, most important, because of their age, the elderly are singled out for differential and unfair treatment.” That was over 20 years ago, and was defined by the attitudes of the ascendant Baby Boomers who 20 years before that did not trust anyone over 30.  This is an example of conflict between groups - a sociological fact.  It does not prove that even then, old people were the underclass.  Today, we surely are not.  Old people vote and young people do not, thus who is the dominant group is arguable.  Moreover where oldest and youngest workers compete directly (retail and fastfood), the seniors have the advantage, being desired for reliability and judgment.

Kathryn A. Dietrich's 2007 work, Instructor’s Resource Manual with Test Bank for Mooney, Knox and Schacht’s Understanding Social Problems (Fifth Edition) continues the claim that seniors are an underclass..  “In 2003, median income for individuals age 65 and above was $14,000 with 29.3% reported incomes of $10,000 or less.”  (page 527) When individuals live together, it is their combined incomes that counts.  In America, about 70% of all people own their own homes, with ownership highest among the older groups.   Moreover, older homeowners typically pay no mortgage.  They can borrow against the equity of their homes with negative mortgages.  Their incomes from investments, annuities and funds may or may not be reportable and other incomes may not be reported.  Non-working children are the single biggest drain on family income; and most seniors have not accepted that commitment. 

            The plight of those who are trapped in harsh circumstances must not be overlooked, but neither should it be generalized beyond its bounds.  Aging necessitates increased medical care.  Even if there is nothing wrong – or more likely, nothing symptomatic – regular medical checkups are critical to health maintenance.  Office visits cost money.  So do prescriptions and other regimens.  That said, the fact is that the present generation of elders is far better off than any previous generation.  Those following the Baby Boomers have every reason to expect even better outcomes. 

            Medical care is more than fixing things that are wrong.  “An ounce of prevention is worth a pound of cure,” says the old adage.  “An apple a day keeps the doctor away” reminds us about the importance of diet in general and vitamin C in particular.  Vitamin C (ascorbic acid) was the key to Linus Pauling’s recommendations for longevity.   Pauling himself took three grams of it every day.  He live to be 93.  When he was born in 1901, his life expectancy was 49.6 years.
  

The statistical probability of living longer is increasing.  The Social Security Administration actuarial tables give you zero probability of another year after 80, but continue the tables to 110 years of age to account for the increasing number of people who outlive their expectancy.  

Pauling’s recommendation for ascorbic acid remains controversial and not generally recognized by the medical community.  However, the theory is sound.  Like other vitamins, ascorbic is an anti-oxidant.  As such it protects against and repairs damage caused by free radicals.  The free radical theory of aging developed by Denham Harman.   Free radicals are partial compounds within the chemistry of the body.  Some are necessary.  Others float about as a kind of garbage, attaching themselves where they are neither needed nor wanted.  Free radicals damage fats, proteins, and nucleic acids.  Peroxidized fats cause arterial plaque.  Free radicals attack DNA and RNA causing cancer.  When lysosomal membranes are broken down by free radicals, the released enzymes (acid hydrolases) cause rheumatoid arthritis.   Just about all vitamins have anti-oxidant qualities, though C, A and the family of E seem to be the strongest actors.  In addition, chemicals BHT and BHA  commonly found in foods in America also protect against free radicals.  Some theorize that the addition of these preservatives to our processed foods has been responsible for the lower rates of stomach cancers among Americans and compared to other industrialized populations.



            Free radical theory is just one of several approaches to life extension.  Aging is not one thing, but a combination of processes and experiences. 

• Aubrey de Grey developed Strategies for Engineered Negligible Senescence and explained his theories in several books.  The Mitochondrial Free Radical Theory of Aging earned him a special doctorate from Cambridge. 
• John Sperling (founder of the University of Phoenix) has a project called “Genetic Savings and Clone” which failed to reproduce a dog, but which did create one CopyCat. 
• Ray Kurzweil inventor of optical character scanning, digitized audio and other technologies wrote Fantastic Voyage: Life Long Enough to Live Forever  and four other books on the same theme.  Kurzweil believes that future technology derived from the frontiers of today’s computers will enable us to store the essential aspects of personality in a useful, interactive format.  
• Cryonics is not “freezing”  but lowering body temperature may allow long-term storage and recovery of a human body.  The goal might be to hold you until a cure can be found for some serious problem.  Some people might prefer a slow trip into the far future. 

            Durk Pearson and Sandy Shaw collected much of this information about free radicals and other theories for their books Life Extension a Practical Scientific Approach and The Life Extension Companion. 

ALSO ON NECESSARY FACTS

Aging

Social Stratification in the Academy

The Roots of Poverty

The Market is Always Right -- About the Market