CT Scans After 11 Months on Tagrisso

Okay, no photos for this post, just milestone dates:

December 8, 2017  CT Scans day

May 5, 2017  Last previous CT Scan day

January 15, 2017   Swallowed first 80mg Tagrisso pill

Whoa.  That’s seven (7) months between scans! Was I apprehensive on December 8, 2017? Nope.  I was more concerned that my cabbie might not show up in time or at all. I don’t believe taxi drivers will show up until they show up.

Non-emergency medical cab rides are subsidized by my city in California.  I like it.  The $45 round-trip costs me $8 plus a small tip dictated by my mood and the driver’s attitude.  The subsidy has nothing to do with the resident’s financial status.  The city simply loves its adorable seniors.  Had I known about the subsidy sooner, I would have not gotten lost looking for doctor’s offices using the public transportation system. It always happens to the new kid in town.  But hey! I learned something new in each of those bad-hair sweaty days plus they provided fodder for my blog.  Always looking at the bright side!

My one-man-band Onc, Dr Smiley, does things differently from the Oncs in teaching hospitals.  First he orders the blood tests then we do a face-to-face talk to discuss the results.  This time, he said all the readings were fine except my liver enzymes were high.  What could that be, I asked.  It could be an infection, it could be cancer, he said.  What! I’ve had those high liver enzymes before and they were caused by neither infection nor cancer.  I remember returning to my alma mater Google University to find out more about AST’s and ALT’s and I came up with all things that were music to my ears. I wanted to tell him that but I didn’t.  I simply smiled to match the built-in smile on his face.  Then he scheduled my chest and abdomen CT Scans at a hospital with which his practice connects.

This hospital does things differently too.  They had me drink this chalky barium concoction over a two-hour period prior to the CT Scans. Then came the CT Scan motions.

The scans took place on a Friday.  The following Monday morning a message from Dr Smiley lit my smart phone, which is always on Mute so that I’ll miss all calls and appear important.  The results must be in, I presumed.  The phone also indicated there was a text message from my son.  I checked that one first.  Priorities.  In response to my text, he said he had used two kinds of sauces on the fried tofu that he served me in his house the day before Thanksgiving.  I fought the feeling of perpetuating the culinary arts conversation.  I had to move on to listen to Dr Smiley’s voice message.

The message actually came through the female secretary’s voice.  Everything is fine, she said. The chest is good, the abdomen is good.  The tiny nodules too many to count still showed up in both lungs but they are stable.  If you have any questions, give me a call.  I thought, here we go again.  The nameless dots in my lungs aren’t going nowhere.  In my mind I declared them scar tissues.

Here’s another thing that the good doctor does differently: No face-to-face meeting to discuss good scans results.  I find that strange, but holy guacamole, good news is good news which ever way it is shared.

 

 

 

Nearly 8 Months on Tagrisso

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On the evening of January 18th, 2017 I took my very first Tagrisso pill.  It had been 14 days after the CO-1686 boat unceremoniously abandoned me at sea. Captain Poksceva aka rociletinib refused to play with me any more.  It was okay with me.  It’s the attitude I take when bawling and squalling are not an option.  I square my shoulders, primp my growing platinum blond hair, and sashay forward.

Now it’s August and I realize getting on the roaring Tagrisso train after progression on Poksceva was a good third act after Tarceva and Poksceva.  My last CTscan which was done in April this year, showed Tagrisso had devoured 80% of the tumor.  The shrinkage calculation used simple mathematical proportions. The cancer medical professionals probably have a more sophisticated discombobulating method of computing the shrinkage of the nasty main tumor at the bottom of the lower lobe of my left lung, but who cares?  Shrinkage is shrinkage in any language.

Let’s look back at the distant past a little.

I have been around the shrinkage bend a couple of times.  The first time was five years ago after 100 days (3 months 10 days) on Tarceva.  It was the same thing.  Tarceva gobbled 80% of the tumor right off the bat, leaving 20% to hang around my lung.  For the next 17 months the CTscan image every three months showed the same 20%.  The good Onc, one exchange Irish doctor, and myself hoped it was only scar tissue.  There was really no CTscan image afterwards that showed the 20 percenter increased in size, but the world-class Onc got a wild-haired notion to make fine-toothed-comb analysis of my lung images. After careful and thorough eyeballing of old and new images,  he noticed three tiny nodules that weren’t there before.  It was an Aha! moment for him.  I forgot what kind of moment it was for me but it would be safe to say it was a hacked-off moment. Henceforth he referred to the three tiny discoveries as little fellas that confirmed his suspicion of a progression.

Nearly 3 years of CTscan images under the CO-1686 trial showed the same 20 percenter. Nothing grew nothing new.  Not a word on the little fellas. I imagine they are still there among the tiny nodules too many to count in both of my lungs. They may be cancerous, maybe not.  No one knows what they are.  What matters is that they are not giving me anything –  no pains, no shortness of breath, no coughs, no loss of appetite.  Maybe they are like freckles on a redhead kid’s face. They are just there.

Back to the present…

Then the 20 percenter showed progression in spite of the CO-1686 drug.  The clinical trial folks, with whom I developed a good relationship, had to transfer my care to a one-man-band onc whom I named Dr Smiley.

Dr Smiley examined me the other day 4 months after the last scan.  He jammed his bare hand in my armpits to feel swollen lymph nodes.  He found none. He felt dampness instead.  Walking in the hot sun even under an umbrella drenched me. He kneaded my neck to feel swollen lymph nodes.  He discovered none.  He noticed instead hidden on a fold on my neck the faint seam of my long-ago parathyroid surgery. He looked for swollen feet and ankles. Nothing there.  He was dictating his findings to a young techie girl.  He listened to my lungs and said, There is a velcro sound from the left lung.  I said, Whoa! What is the velcro doing in my left lung?  He answered, That’s probably where your cancer was. I liked the past tense.

Dr Smiley concluded the visit by announcing that he will not order a CTscan this time because the images and report from the last one are fantastic, my present vitals are great, and I have no unexplained weight loss, pain, shortness of breath, coughs, and other symptoms.  He set the next appointment: November 28th, bloods and CTscan.  That would put me on the every-six-months schedule.

I am not complaining.  He seems to know what he’s doing.

 

 

 

 

 

 

 

 

Insurance Company Denies Payment

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Not a Pretty Picture!

 

My life is filled with conflict.  Fortunately, I dig conflict.  Being a self-proclaimed Drama Queen, I thrive on conflict.  Conflict becomes me.  Okay, you get the drift.

When it became almost clear that rociletinib, the CO-1686 trial drug aka poksceva, had started to differ with me as to its purpose in my well-being, my awesome Onc, Dr Brevity, decided to requisition the services of Guardant.  Guardant is the noted high-tech company that analyzes human blood to determine the types of mutated cells that are coursing through the veins of a cancer patient.  Dr Brevity said he wanted to know what happened to the cancer cell that was once identified as T795, a mutation developed out of my EGFR in exon 19 deletion to resist Tarceva.  Cancer cells do learn to outsmart cancer drugs!

I asked for the results of Guardant’s lab analysis as soon as it became available.  Like the Good Doctor, I wanted to know what new nasties were parading in my system.

I read the report with great interest.  The only problem was, I did not understand a thing about analysis of DNA, genes, and molecular pathology.  Well, what do I know about molecular pathology? I’m a civil engineer; I’m into sewers.  But I got the hang of what the report was saying: Those analysts did not know what to make of the results either because there was not enough material in my blood, consequently, they did not know what treatment to recommend.  So, now, a whole slew of us including Dr Brevity, the analysts, the CO-1686 trial sponsor, its employees and associates, and me, know more than what we did before Guardant came into my existence.  Zip, zero, nada.  And my insurance company put me and only me on notice that they will not pay for the lab’s analytical services.  In other words, you, Ms Senior String-Bikini Babe, shall pay.  The scenario reeks with conflict of interest!  The insurance company’s interest in my funds conflicts with my interest in not paying for anything whenever possible.

Well, I happen to be a veteran of conflicts.  In public events, when the emcee asks veterans in the audience to stand up and be recognized for their patriotic service to the country, I attempt to join those who rise, but a companion always pulls me down and puts me in my place.

I read the letter of the insurance company word for word and found I have 60 days to file an appeal.  I can name a relative, friend, attorney, doctor, or someone else to act as my representative.  The most logical representative is Dr Brevity because he was the reason for the payment denial, which, by the way, was given:  Medical records requested were not received.  In order to determine financial liability or medical necessity medical records are required to assist in a clinical determination. As these records have not been received, this claim is not payable by the insurance company.

It was my turn to put somebody else on notice.  And I did.  Voila!

(to be continued) 

I’d be glad to hear your experience if you have any on insurance payment denial of Guardant’s services.

 

First Three Months on Tagrisso

Happening soon! I am talking about the upcoming CT Scan and blood tests this month after my first 90 days of taking 80 mg of Tagrisso once daily.  I had been popping the pills religiously at 6:00 every night except for one evening when I completely forgot all about it.  What happened was, three Foodies picked me up at 4:30p.m. for a 5:00p.m. seafood dinner at Bonefish Grill. Six o’clock simply got lost in the hoopla.  It happens when a mug filled with an awesome designer draft beer and a heaping plate of bang-bang shrimp are strategically placed in front of my eyeballs.  It was not until midnight that the missed Tagrisso dawned on me.  I decided then and there that the occasion had risen to switch Tagrisso-taking time to the crack of dawn, as in 6:00a.m. and get it out of the way for the day.  It does work much better.

Tagrisso continues to give me zero nasty side effects:  no upset stomach, no shortness of breath, no fatigue, no diarrhea, no constipation, no rashes, no dry skin, no pain, no swelling of anything. Nothing.  I get additional bronzing and Vitamin D directly from the California morning sun without adversarial effect.  I keep a vigil on my eyebrows to catch any signs of bushiness. I scrutinize my eyelashes daily for indications of becoming mutants. As a matter of fact, I have noticed changes.  My eyebrows have developed a new growth pattern.  The outer ends curve upwards like handlebars.  And the hairs are coming out long and white or gray.  I have become the female Mr Clean! I’ve trimmed them and plucked the wayward hairs once already.  I don’t blame Tagrisso for the graying.  After all I am waaay past the age of innocence.  My lashes that Tarceva left stubby have been growing back darker and longer, making the eyes more soulful and fraught with the come-hither look.  This development is getting me all stoked!

I’m truly curious what the upcoming CT scans will reveal.  Is the adrenal occupier still on its perch? Then there’s the Flying Saucer at the bottom of my left lung – the portion of the tumor that Tarceva did not wipe out but Rociletinib kept at bay for nearly three years.  Did it grow bigger, get smaller, or stay the same? What happened to the Milky Way in both lungs? Are the mysterious tiny nodules still too many to count? What are they, anyway? This is exciting!

This upcoming CT Scan would be my first outside the university environment. Since my cancer diagnosis in 2012, all my cancer treatments, tests, and scans had been in a succession of four teaching hospitals: University of New Mexico, University of Colorado, University of California in Santa Monica, and University of California in Irvine.  Now I am with a one-man-band Onc in Southern Orange County.  Ta ta to stardom or diva-hood in a one-man-band atmosphere.

Since dropping Rociletinib, the CO-1686 drug, and starting Tagrisso, I have not set set foot in ol’ Club Med (UCI Orange).   Life is more enjoyable when it is not designed around three-week blocks of time.  Life is so much simpler without drug-induced diabetes and without Metformin. Life is a beach indeed.

My son, his wife, and their ten-year-old son – an only child – the one who they thought would get past statutory age still unclear on the concept of rhyming, visited me for five days in my manor in the retirement resort living at its best.  I delighted in the opportunity to host them.  However, having given up the vehicle to be true to my new minimalist lifestyle, I became the tourist!  In their rented car, they hauled me around town.  We hiked a steep trail that took an hour and a half round trip.  We gloated over our accomplishment of making it to the top where we could see the grandeur and beauty of the Pacific Ocean.  My chest swelled with pride in going to toe to toe – albeit a tad slower – with the young ones during the ascent. But the descent was another story.  My son had to hold my hands.  Otherwise, my bod rolling down uncontrollably to the bottom of the canyon like a  fallen log was a distinct possibility.

I miss Dr Brevity and his staff.  Obviously the feeling is mutual.  Out of the blue his RN took time from her extremely busy schedule, phoned me and asked how things are going. The trial coordinator sent me a social media message saying “I am missing you that’s all.” I like to think those sweet thoughts could pulsate vibes to the CT scan machine to take wonderful images during my scan.  Wishful thinking is good.

Moving on After the Storm

My Octo’s sudden demise was like another wayward wind in my life.  It blew in and blew out, and once again, I’m in the corner of Healthy and Happy, amazingly standing upright, with not a tress of silver hair out of place. It happens when the serial widow believes she can walk on water from the eye of the storm across to dry land. It’s all in the head!

I’ve had 2 blood tests in the CO-1686 non-trial without Octo.  By the way, both times, Dr Brevity assured me, Labs are good. In Octo’s place as caregiver was my baby sister who is 7 years younger than me, size petite small, colors her shiny page-boy hair squid-ink black, wears junior style fashion, and dances like Emmitt Smith should be tossing her up in the air in Dancing with the Stars.  But I have an edge: I am a retired successful professional engineer. Big deal. She is a retired successful attorney! Ah, I remember, Youth’s inexperience is no match to the cunning of old age.

In the 60’s and 70’s I was a young chick pioneering in the engineering world which was then controlled by men.  As such, I encountered one spirit-crushing setback after another after another. It was in those years that I learned to vacate an adversarial situation quickly, let the past run through cleanly, conserve energy for the next battle, and eventually win the war.  Becoming a widow again 12 years after the first widowhood would require the same modus operandi if I choose to enjoy the stroll on the last mile of my life.  And that’s what I choose.  Sulking is so not me. Thus, the motivation behind this post:  I’ve accumulated so many nuggets of wisdom over a huge slice of a century that it would be a crying shame if I did not share them with those who give a damn. I am also kind of running out of justifications for my narcissism!

A few days after Octo’s death, my sister and three of my best girl friends flew or drove in from Dallas, Las Vegas, and Albuquerque to distract me from the isolation of grieving.  Upon their arrival, I noticed their furtive glances the first time I blasted a flattening laugh.  Is this a grieving widow in need of distraction? They must have wondered.

The ladies discovered that I have reinvented myself as Interior Designer Extraordinaire.  For a complete change of atmosphere, I bought a tiny house.  For the first time in my life, here is a house that is clearly mine, not my husband’s and mine or ours. It’s all mine to play with and in.  It reflects only my taste, which we do have to redefine taste.

In the Great Room, my bffs and I did my yoga poses together and delighted in the sounds of bones creaking.  Let’s go dancing, They offered after scouring the social activities in the newspaper of the over-55 gated community where I reside in Southern Orange County, California.  They did not have to drag me kicking and screaming.

To the dance we went. Thank goodness we have reached the age where the  male-female partnering rule has been bagged.  Amidst traditional dancing couples, we swung and swayed, boogied and chachaed until sweat beads formed on our foreheads. In between numbers we sipped water and ate cookies and raisins.  Yes, raisins in tiny corrugated paper cups. What were the refreshment committee members thinking? Soon, the dance event ended. It was 9:00 pm!  It happens when too many old people populate a retirement place and they need to be in the  snoring mode long before midnight.

The next item on the agenda was to establish a new routine, to find a group of fun people, those who share each other’s interest. The village boasts 200+ clubs and organizations that cater to all possible interests of humans and animals.  Dancers, knitters, bible thumpers, cat lovers, Republicans, horseback riders, photographers, health buffs, grievers, bridge players, ham radio operators.  Name it, the village has it.

The Foodies Club got my attention.  In its welcome material, the club defines a Foodie in a  long, drawn-out manner, which translates to a person who is extremely interested in food.  I attended a meeting to scope the club out. For an hour, while eating gourmet ice cream topped with a concoction chosen from an array, I listened to reports on existing restaurants closing, new restaurants opening, food service businesses for the home-bound, curious, or lazy, or all three, and an announcement about an upcoming Moroccan dinner.  The Foodies seemed a happy lot but they are no match to Cannabis Club members in the giddy department.

Whichever groups I decide to entertain myself with will have to wait.  Before I settle down to a new routine, I’m spending time with family and friends who have been very supportive. I’ll also re-establish old connections that had been disrupted. Then back to Southern Orange County for retirement resort living at its best. So the commercial says.

Bottom line: It’s all in the head. I can be as isolated or as involved as I choose. All I do is get a mindset, then say, Let’s do this!

 

 

 

 

 

 

 

 

 

 

 

 

A Ring-Side View of Hospice

The earliest I heard of the word hospice occurred when my first husband was hospitalized in 2004. He had been diagnosed with end-stage renal failure ten years back. We had known then that one day the kidney disease would rear its ugly head and we’d have to deal with the inevitable – the end of his life. That fateful day came. His condition worsened and his body system started to shut down. The head nurse reluctantly suggested hospice to me.  Equating hospice with death, the very word shocked me to the core.  Well, hospice did not have a chance after all. His deterioration hastened to a point where all the involved specialist physicians voted to give my family the dire option of removing my husband’s life support. Being the wife, I had the unenviable task of releasing his end-of-life directive: Do Not Resuscitate (DNR). The hospital bed literally became his death bed.

That was 12 years ago. Last month I watched my second husband, 82-year-old Octo, leave his body on his death bed after only 7 days in hospice. After 8 years of marriage, I became a serial widow.

Diagnosed with acute myeloid leukemia, Octo’s health spiralled downward rapidly to death in 3 months following 3 treatments that included a clinical trial. He had been needing blood transfusions at least twice a week. Finally, his primary care physician mercifully recommended hospice.

Octo had always refused any talk of mortality stuff like last wills and testament, power of attorney, and end-of-life directive.  After the leukemia diagnosis, I told him, You and I are now in a race for the grave.  He did not appreciate graveyard humor, but his primary care physician forced him to come eyeball to eyeball with death.  You have three months my friend, stated Doctor Diplomacy.  For consolation, the good doctor added, You are not alone.  We all have a beginning, a middle, and an ending.  Octo eventually warmed up to the morbid sense of humor.

Henceforth, Octo and I discussed hospice as if we were talking about the movie for our next background acting project. We both thought hospice was a place, a building. Only at signing time did I realize that our manor would be the venue for the hospice action and I would be the hospice majordomo. Before Octo’s signature ink had dried, it suddenly hit me that the man who had been playing a major role in my life for the last 8 years would in fact be gone for good. Of course there was no guarantee that I would not exit this earth first, but the hospice reality was so there and then. I  choked up all day.

Hospice Day One started with the visit of the hospice nurse, an RN. She took Octo’s baseline of weight, blood pressure, pulse rate, arm circumference, etc. Still mobile, Octo slept a lot in the master bedroom or in the guest room. He had the run of the hospice house.

Day Two. Ms RN gave me, away from Octo’s sight, the inevitable patient needs: diapers, hospice journals, and Comfort Kit consisting of morphine, measuring syringe, Lorezapam drops for anxiety. She taught me when and how to dispense them.  In Octo’s face, she suggested a hospital bed. Bullshit! Declared Octo adamantly.

Day Three was uneventful.  He had a bite of a banana, the only food he wanted, and with water, his only intake for the day.  I did not force him to eat.  First, Octo was a hard-headed old mule.  Second, the purpose of hospice is neither to impede nor speed death but to let nature take its course.  A couple of times we laid in bed, he in a reflective mode and I a listener. I made many mistakes in my life, he said ruefully. I said, You sure did, and I laughed. He cracked a smile, no belly laugher, he.

Day Four. He did not want food, only water. He did not ask any more for his daily pre-hospice medicatons. A couple of times we laid in bed again, he reflecting some more. Long reminiscences.  My thoughts jumped between them and my strategizing of the next sushi dinner.  It happens when one is in the twilight zone, straddling one’s life and another’s imminent death. One needs protein.  He stayed in bed most of the time except when I caught him naked as a jaybird and trying to climb into the bathtub.  His body trembled, visibly too weak. You are going to fall! I screamed, and like football safety Junior Seau, I tackled Octo around the waist from behind. Big mistake! I did not have the required strength. He wiggled his body and sent us both on our butts on the tiled floor.  He tried to stand up.  Hold on to the wall! I screamed.  His trembling hands groped and grabbed the shower curtain and  the curtain rod came down on our heads.  Frustrated, I stood up. He sprawled out. After resting, he very laboriously, a few inches at a time, crawled toward the hall.

I decided it was the perfect opportunity to find out if the hospice’s touted 24-hour phone service really worked. It did, but Octo heard me talking. He yelled, Don’t call anybody! I don’t want those emergency people here! I replied, I called the hospice, our 911. You need help to get back on your bed. You need a hospital bed. Bullshit, he said. I’ll crawl to the bed. I answered, But you are facing the wrong direction! I gave him a pillow and he slept on the floor under the door jamb, half his body on the living room and the other half on the guest room.  I phoned a retired RN friend. She suggested I tell the hospice everything, or I could be blamed. That sure sent me shaking on my bare feet.  A pair of the hospice’s emergency personnel came and collected Octo from the floor and relocated him to the bed. The RN did his vitals and made Octo promise to not escape from the bed.

Day Five. Hospice delivered a hospital bed and a side table. Two burly men came and transferred Octo from the guest bed to the hospital bed.  To my surprise, Octo thanked them, then went to sleep. After the hospice people were gone, he opened his eyes, and insisted, Get me out of this hospital bed! I replied, Help yourself.  I knew he couldn’t.  A hospice health aide gave him a sponge bath and a clean shirt, changed his wet diapers, and cleaned his mouth using toothettes. To the aide’s amusement and mine, Octo motioned to receive a repeat of the mouth washing. He returned to deep sleep afterward.

Day Six. Having no food for four days, no water for two days, and no blood transfusion for a week, Octo was nearly comatose. He breathed laboriously through an open mouth. He fidgeted and grimaced. The hospice RN told me as she changed his diapers, Those are signs of anxiety or pain and time has come for anxiety drops, then eventually, morphine.

Day Seven. The hospice RN gave Octo a sponge bath, changed his shirt and diaper. He slept throughout the process.  That night, his breathing was so heavy and loud it could be heard from the other room.  Then suddenly, around 2:00 a.m., an eerie silence blanketed the house.  I called hospice. The RN came, declared Octo dead, and made one phone call after another.  The mortuary people arrived, followed by huge uniformed law enforcement men, presumably to ensure no foul play was involved. Presumptions like that happen when the hospice majordomo is an Investigation Discovery True Crime junkie. Finally the RN showed me how to properly dispose of all the leftover drugs.

Soon, hospice people were gone.  My first husband’s brother and his wife both of whom had uncannily arrived five hours earlier to give me loving moral support marched to their bedroom. In my bedroom, after laying myself down to sleep, I let out a huge sigh of relief that might have reverberated up to the next zip code. The sigh released my body’s tension, relaxing every fiber of my being.  It was Liberation Day for Octo and me! He gained freedom from the agony of pain. I became free to flee from the twilight zone, armed with new knowledge and an appreciation for life as well as for death.

I’m back focused on life. I still have some living to do.  Like my favorite song says, “I’m gonna live, live, live until I die. …..Before my number’s up, I’m gonna fill my cup..”…Then I’ll have another hospice experience, but that’s for another storyteller, another day.

 

 

 

 

 

 

 

 

 

 

 

My CO-1686: Elevated Liver Enzymes

The liver enzyme elevation was just another episode in Feisty Heifer’s continuing saga in the CO-1686 clinical trial boat as it sails toward the sunset.  I want to share the story because (a) it has useful information for anyone who cares to know, and (b) I get my jollies out of fantasizing that some people actually read my blog.

Two weeks before the ODAC speech trip in April, I had my regularly scheduled blood analysis and consultation with the Good Doctor. The drill has become second-nature to the registration clerk who asks me every time if anything has changed in my insurance, to the phlebotomist who draws my blood with a smile and a small personal story that I draw from her, to the trial coordinator who collects my now-inconsequential dosing diary, and to Dr Brevity who zooms in and out of my life in a fraction of an hour. Usually he tells me, The labs are good, and proceeds to the stethoscope motions that signal the end of me in his busy schedule. But that day was fateful.  Your liver enzymes are elevated, he muttered.  How elevated ? I asked, perturbed, but with the unmistakeable air of authority of a blogger who trawls Google University (GU), I added, Are you talking about ALT and AST?  Yes, he answered, and gave me the numbers: ALT 125 (normal range 7-52) and  AST 88 (normal range 13-39) then asked, What have you been eating? Seafood?

OMG! My liver enzymes were more than twice the normal upper range.  Suddenly visions of my liver oozing toxic crud into my bloodstream flashed in my head. I thought for a moment, then light dawned.  I remembered lately I had been eating a lot of deep-fried oysters and loading up on sushi for no celebratory reason. I am simply an environmental eater kinda old chick.  Place a heaping platter of jalapeno-topped nachos in front of me while we chat and next thing we know they’ve evaporated. That’s assuming the bar maid is plying us with ice-cold cerveza.  For my conversation with Dr Brevity, I limited the verbiage to oysters. You have to be careful with those things, he warned. I disagreed and tried to dazzle him with scientific data:  I fry the oysters in 375-degree Fahrenheit hot oil for 6 minutes, enough to kill the pathogens. Unimpressed, he strode out of the examination room and moved on with his life.

As soon as I got home, I rushed to GU and audited some courses. At this point, I must recite the mother of all disclosures. I am not a physician. My academic attainment closest to a medical degree is that the Big Kahuna of Lung Cansah Research refers to me as “the diva.” I’m not dispensing medical advice; I just have this crying need to showcase the diva’s Inner Healer.

First, GU gives definitions of ALT and AST. Translated simply, they are stuff that may indicate liver damage. According to GU, 2 to 3 times the normal value of ALT and AST is considered mild. The mild elevations might be caused by food, alcohol, or certain drugs. Maybe the numbers are something to worry about, maybe not.  I zeroed in on the worry angle. Worrying in moderation is good. It starts the brain to focus on a problem and find solutions.

I eliminated CO-1686 as the cause of my liver enzyme elevation because why now after having been on the trial for nearly 2-1/2 years? Of course, anything is possible.  I assumed for one second that oysters were the culprit, then thought, Nah! I had been eating those things raw since time immemorial with no consequences except serious allergic reaction early on, which I fought and beat resulting in immunity to oysters. Of course, my self-styled immunotherapy at age 8 could have killed me. I’d even dare say those oysters were contaminated because growing up in the Manila slum where hunger trumped hygiene, contaminants were a staple in the diet. It was a place where sanitary food, when ingested, induced withdrawal symptoms. So I searched for other causes of elevated liver enzymes that might match my circumstances.

I read that overexercising can aggravate muscles and cause them to release ALT and AST that adversely affect liver enzyme tests.  Now, we’re cookin’! In the week preceeding the blood test, my husband Octo had fallen ill and was confined in a hospital just outside our gated community.  Being the perfect wife that I fancy myself as, I visited him daily.  I also figured it was a great opportunity to get my exercise out of the way.  Talk about exercise! My daily visit involved an hour round trip uphill, downhill brisk walk.  Call that my cardio.  My arms got their workout as I waved them vigorously at the gate guards.  The big smile that I flashed to anybody who made eye contact exercised my facial muscles. The spring in my steps massaged my calves.  It happens when one wears Z-Coil shoes.

I remember at the end of that week, I felt like I had been trampled by stampeding bulls.  Every muscle of my body ached.  It admonished me that all I need at my age is a leisurely 20-minute walk along a leafy creek – not the Bataan Death March kind of trek.

I listened to my body like I have always done.  I chilled in the physical exercise department in the three weeks leading to the next blood test.

The day of reckoning came.

Labs are good, muttered Dr Brevity. How about the elevated liver enzymes? I asked. What liver enzymes? he countered. He had already forgotten about them and nothing about them in the report grabbed his face. The one-off problem had resolved.

Fresh oysters tossed in my homemade gumbo sounds pretty yummy right now.