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This is part of the full text of the medical memoir "Cancer Patient" written by Hugh Cook. The full text has been published online on a free-to-read-online basis. This autobiographical non-fiction account deals with the author's initial health problems, diagnosis, and treatment with chemotherapy and radiation therapy.

The complete text of "Cancer Patient" is here on this web site but is also available for purchase from amazon.com as a proper printed paperback book. The full text may also be purchased as a download (a PDF file) from lulu.com for US $5. Go to lulu.com/hughcook

For a chapter-by-chapter breakdown of what's in the book (in its online version, in the PDF version and in the paperback version), see:-

Table of Contents

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diary       site contents       essays       stories       flash fiction       poems       novels

CANCER PATIENT is a medical memoir which deals with the author's autobiographical experiences which involve, amongst other things, chemotherapy, radiation therapy, a brain biopsy, a lumbar puncture (and then some more lumbar punctures), treatment with Ara-C, treatment with vincristine, treatment with methotrexate, treatment with radiation from a linear accelerator, and a vitrectomy (an operation to remove the jelly from an eye). This is a non-fiction account but it does contain a couple of fictional stories, clearly identified as such, and it also includes some poetry.

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Chapter Five

Summary

Back in Japan, the author does some online research into, amongst other things, sarcoidosis, a degenerative disease which can cause both weight loss and blurred vision. The author lines up an appointment with a Japanese ophthalmologist, Dr. Lux.


        2004 February 17 Tuesday.
        Got back from New Zealand on Friday 13 February, went up to Gunma on the 14th to see Murasaki-san, came back the 15th, worked yesterday. Home alone until Thursday, then Murasaki-san comes down to Yokohama and stays for a few days until she goes up to Gunma again.
        While in New Zealand, got an answer on the eyesight trouble which has been causing me grief for over a year now: some kind of chronic low-grade inflammation. The right eye is misty because it is filled with inflamed cells. Treatable with steroids on a short-term basis if it becomes desperately bad.
        Also, while in New Zealand, I finished nutting out a complete start-to-finish plot for the novel BAMBOO HORSES, and it's this that I'm working on now.


* * *


        2004 March 21 Sunday. 1529.
        Uploaded text of THE WORDSMITHS AND THE WARGUILD to my zenvirus.com web site today. Inputting the text has kept me fantastically busy. Now trying to decrypt the medical notes (handwritten) I got from the ophthalmologist I saw in New Zealand, this in preparation for an appointment on Tuesday.
        He saw "2 K.P." (two cells, I think) and a search of the Internet turns up the fact that "KP" means "keratic precipitates".

* * *

        The above are a couple of diary entries from 2004. Does "2 K.P." in fact mean "two cells" or are keratic precipitates actually accumulations of cells? I still don't know. Having my disease did not make me an expert in the disease.
        Anyway, very roughly, keratic precipitates are accumulations of organic junk which stick somewhere inside the eye and which can be observed by an eye doctor using a slit microscope. Keratic precipitates do not point directly to any one particular disease because they can be associated with a number of medical conditions. However, they do indicate that something is going wrong inside the eye.
        In retrospect (looking back at early 2004 from the perspective of 2005) I'm surprised at what a low priority I put on my health. With time on my hands, I focused on putting the text of my novel THE WORDSMITHS AND THE WARGUILD on my web site. (The book, one of a series, was more or less out of print, and the guy who sells the remaining books in the series, slowly, at the rate of a few copies a year, thought it would be advantageous to have the out-of-print book available on the Internet.)
        As has been related, I saw an ophthalmologist in New Zealand early in February 2004 and was told that there were "K.P.s" in my right eye. However, it was not until late March that I finally got on the Internet to find out what "K.P.s" might be, even though this would only have taken me a few minutes.
        It turned out that "K.P.s" are "keratic precipitates", which I found defined online as "accumulations of inflammatory cells". These K.P.s stick to the cornea and can be seen by an ophthalmologist during an eye examination. They occur in uveitis, which is an inflammation of the uvea, which is part of the interior of the eye.
        At this stage, before having looked on the Internet, I was not particularly worried about my eyes. My disaster had been slowly unfolding for months, but I was unaware of the fact that it was a life and death disaster, a challenge to my very survival. Rather, I thought I knew what the problem was: some kind of chronic low-grade inflammation. I also thought I knew what the solution was: wait for it to go away of its own accord, and, if it doesn't go away, get a prescription for the appropriate steroids needed to treat it.
        What I found on the Internet did not make me feel worried. Rather, if anything, it made me feel confused. There was any amount of data online about uveitis and keratic precipitates. Unfortunately, however, a number of different diseases may cause the formation of keratic precipitates, so, as already noted, the discovery of K.P.s does not point in the direction of any particular disease.
        On my first trawl through the Internet, the terms which came up included toxoplasmosis, sarcoidosis, non-Hodgkin's lymphoma, Reiter's syndrome and a whole bunch of other things. Which of these, if any of them, applied to me? I ended up thinking that perhaps the answer was sarcoidosis.
        When I saw Dr. Kiwi in New Zealand, he asked me if I had a dry cough. The disease sarcoidosis, which I'd never heard of before, turned out to be a kind of inflammatory condition, the cause of which is unknown, which commonly results in a dry cough. Even though I did not have a dry cough, sarcoidosis seemed to be a candidate for the villain of the piece, since the dry cough is not compulsory.
        However, as I wrote in my diary, "I'm at the hypothesis is endless stage."
        The Internet gave me no simple answers. The number of diseases which can result in inflammation of the eye and the formation of keratic precipitates is bewildering.
        I found myself writing:-
        "I can't rule out Lyme disease ... how about multiple sclerosis?"
        While the Internet did not help me to diagnose my own condition, using the Internet did prove very useful. What I found was that when your symptoms are keratic precipitates coupled with weight loss (the combination that I eventually ended up focusing on) then the differential diagnosis is very difficult because there are so many possibilities.
        I found case studies detailing how patients went to well-resourced American hospitals and had batteries of tests supervised by properly-qualified doctors and yet still did not get a conclusive diagnosis for months, if ever -- in a certain number of cases, the cause of the problem proves impossible to determine. idiopathic, to use the medical word. Without a known cause. I also found cases in which tests (for lymphoma, for example) initially come back negative but later (six months or so in the future, for example) prove to be positive.
        My conclusions were that the techniques available for interrogating the human body are still primitive and uncertain; that there are a surprising number of unknowns in medicine, including a bunch of degenerative diseases which have not yet properly analyzed; and that there is no magic method for swiftly and inevitably nailing down the cause of a disease which manifests itself vaguely as a combination of keratic precipitates and weight loss.
        This knowledge was useful because it made me understand that what I ended up going through -- a long and unsatisfactory siege of tests and investigations -- is pretty much par for the course. The length, complexity and unsatisfactory outcome of the investigative process did not mean that my eye doctor was incompetent or that the resources of my hospital were inadequate. It simply meant that the differential diagnosis was tough, even for the best of the experts in the best-resourced of hospitals.
        After I returned from New Zealand, the investigations into my condition finally began, without anything in the way of a sense of urgency, with a consultation with Dr. Lux, a Japanese ophthalmologist with whom I kept an appointment on March 23rd.

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The text on this page is part of the cancer memoir "Cancer Patient" which has been posted online. All the chapters of this book are on this website and can be read for free online. However, the text is copyright - all rights reserved. For permission to use this text or any portion of it contact Hugh Cook.

Disclaimer

        This personal memoir of the writer's encounter with cancer (non-Hodgkin's lymphoma of the large B-cell type) attempts to cleave to the truth. However, the text may contain information that is wrong, outdated, incomplete or otherwise misleading.
        This memoir has been written in a time of illness by a cancer patient who, though he feels sharp enough, must admit to sometimes misinterpreting things, forgetting things, or, on occasion, quite simply not hearing things.
        This memoir is designed to communicate the writer's personal experience and is not intended as a source of medical information. Got a medical question? Ask your doctor.

Cancer Patient Copyright © 2005 Hugh Cook.

Hugh Cook

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