Ear Today, Ghoul Tomorrow?

Before and after surgery photos taken on patie...
Image via Wikipedia

Ear Today, Ghoul Tomorrow?

I don’t plan to grow old gracefully. I plan to have face-lifts until my ears meet. – Rita Rudner

Life, for most mortals, is a zero sum game. As one enters middle age, you begin receiving physical past due notices requesting payment for every  act of vanity, gluttony, sloth and stupidity.

Having grown up on the beaches of Southern California, I became accustomed to enduring a permanent state of sun burn.  My delicate adolescent epidermis was in a perpetual cycle of burn and tan – always followed by a reptilian peeling of the skin. In the days where dermatologists existed to treat teens for acne and ancient beachcombers for melanoma, parents did not force kids to lather up with SPF 50 sunscreen. When overexposure to the sun produced second degree burns, mothers would simply apply a greasy, white industrial ointment known as zinc oxide to the afflicted area and hustle you back out into the sun.

Like the Aztecs of ancient Mexico, we were a society of sun worshippers. A tan was considered a healthy measure of a man’s cultural, physical and financial prowess.  Stars like George Hamilton and Robert Wagner personified the benefits of melanin and masculinity. Despite my light eyes and County Kerry skin, I was constantly in search of the savage tan. As with all the seven deadly sins, the Fates never forget to remind you of your deal with the devil.

At the ripe, young age of 35, I noticed a small patch of flaking skin above my left eye that never seemed to heal.  It was no larger than a thimble top. It had a predictable six to eight week cycle of itching, peeling and healing.  I mentioned it in passing to my physician during a rare physical. As a precaution, he sent me to a dermatologist who, after conducting a biopsy, surprised me with a diagnosis of basal cell carcinoma.

My skin doctor further unnerved me by sharing that the basal cell’s removal would require the assistance of a plastic surgeon as the particular area in question had little skin to suture the quarter-sized area that would need to be excised. He went on to describe a Frankenstein type of procedure that would graft skin off my temple by twisting clockwise over open eyebrow.

Only in my mid-thirties, the notion of plastic surgery unnerved me.  I assumed that the only people in real need of plastic surgeons were public enemy number one criminals attempting to alter their physical appearances, aging celebrities and of course, Joan Rivers.  I instantly recalled the Frank Capra Halloween classic, “Arsenic and Old Lace”, where a sociopathic murderer played by creepy Raymond Massey, returns home to threaten his family after being disfigured by his drunken plastic surgeon, Peter Lorre. My active imagination transferred his scars on to my face – a face that not even my dog could love.

I endured the surgery but developed am embarrassing post operative complication when excessive scar tissue accumulated underneath the incision. It appeared as if I was growing a small horn. Since it had been several centuries since horned, pan flute playing fauns were in vogue, I was eager to receive a “horn-ectomy.” Yet, an infection would require that I wait six months for this critical second plastic surgery. In the interim, I learned a lifetime of insights about my own vanity.

The “horn” incident left me with a strong motivation to return to my dermatologist every six months to be probed for suspicious moles, foreign freckles and dubious discolorations.  If the doctor found anything, he would deploy his trusty canister of liquid nitrogen and proceed to “freezer burn” the cells gone wild. Aesthetically, my doctor never seemed to consider the fact that I had a social life. Perhaps he assumed I was a research librarian. You see, a man with freezer burns across his nose, cheeks and forehead looks like someone in the early stages of leprosy. It was inconvenient but I did finally come to realize that the person who most noticed my burn marks– was me.

Fast forward to October, 2010. It had been years since I had been diagnosed with any epidermal irregularities. I was beginning to think that I had finally gotten the skin cancer monkey off my back when the doctor found a small patch of flaking skin on the inside of my ear. What was thought to be a patch of eczema was instead, an aggressive squamous skin cancer that needed to be immediately removed.

The excision surgery called Mohs, involved removing the lesion and any surrounding tissue that might have been corrupted by the cancerous cells. The doctor essentially keeps expanding the radius of his incisions until the adjacent skin is cancer free.  What might start as a laser thin surgical bore can grow into the Grand Canyon. While preferable to the more medieval skin surgeries of the past which usually resulted in pieces of one’s body being removed, Mohs was still invasive surgery in an area comprised predominantly of cartilage – which is slow to heal, quick to infect and impossible to disguise.  I was not quite ready to go Van Gogh.

After a seemingly uneventful surgery, my ear was wrapped and I was sent home to convalesce.  The bandage looked like a battlefield medic dressing and screamed out to anyone passing by, “look at me!”.  It was enormous and came to a rather unattractive point at the top of my ear appearing as though I was either preparing for a journey to Modor or readying for a Star Trek convention. My spouse did what all good spouses do – she lied to me saying, “You – – can hardly notice it.” She was so confident of its total invisibility that she suggested we go to the local Varsity football game to get my mind off the surgery. I was reluctant to appear in public as I knew two-thirds of our entire community would be gathered to socialize and stare at my ear. I could already envision four-year old kids coming up to me and handing me scribbled notes asking me if I would not mind “giving their list to Santa.”

At the football game, I skulked in the shadows like Boo Radley convinced everyone was fixated on my head. I lasted two quarters and declared that it was time to leave.  Later that evening, under a bright vanity mirror light, I surveyed the bullet hole wound and the exposed cartilage. I felt like “Massive Head Wound Harry”, a disgusting character made famous by Dana Carvey on Saturday Night Live.  I started second guessing whether I should have asked the doctor for an appointment with a plastic surgeon.

As a healthcare professional, I had philosophical reservations about elective plastic surgery. Americans spend up to $13B a year on non-essential procedures. What was once a medical profession designed to improve the quality of life for those unfairly dealt deuces in the card game of life, had now become a multi billion dollar industry catering to the insecurities of a society that glorified youth and whispered promises that physical perfection led to personal happiness.

As an addictive personality, I could easily see myself getting caught up in the body image spiral. Despite a regimen of rigorous exercise, there remain parts of my body that categorically refuse to recognize me as their sovereign. These untamed regions of my legs and arms resist my periodic offensives to tame them. As I survey my wobbly inner thigh or stubborn love handles, popular culture chips away at my self-confidence. I  am a failure for somehow not bringing these rebellious bands of bagginess under heel. Perhaps getting my ear fixed would create more problems – like buying that new couch and then suddenly waking up convinced that I needed to remodel the entire house.  Within a few years, I would end up looking like a 15th century samurai.

I do not know what it is about middle-aged men and denial. While men generally age gracefully, they cannot always see the dignity of their salt and pepper patina. Take for instance, my hero Olympic Decathlete Bruce Jenner who now resembles the illegitimate offspring off an orange orangutan and an iguana. Bruce, who should be a star in a TV special, “When Good Facelifts Go Bad”, presides like a eunuch over a harem of micro-celebrity Kardashian women.  He spends his day playing with toys and sleeping while his B-list step daughters disrupt various public places across the US. Bruce is not the only sad sack of surgery. Have you seen singer Kenny Rogers, aka The Gambler, lately? Old Kenny has been stretched more times than salt water taffy and looks as if he is permanently walking into his own surprise party.

And do not think I would forget the ladies!  Ironically, these nymphs of the knife who spend tens of thousands each year to look “different” have actually become increasingly interchangeable.  Between their collagen injections, Botox, liposuction, tummy tucks, forehead lifts, chin contouring and implants – they have created their own subhuman race of taut, buxom human carp. The lists of cosmetic casualties that refuse to go gently into that good night include Janet Jackson (She and Michael are the same person), Meg Ryan, Donatella Versace and Melanie Griffith. Between the collagen gone bad, shifting saline and sagging facelifts, these Brides of Frankenstein are walking warnings of the price paid for listening to that nagging inner critic that keeps whispering that your butt looks big.

In the end, my ear will heal.  I’ll eventually stop worrying that I look like Evander Holyfield.  The bandage will come off revealing a scar and gasp, more imperfection.  It may detract from my physical appearance but in the end, it will be another unique brush stroke on my canvas – a flawed Dorian Gray portrait replete with scars, gray hair moments, crow’s feet and laugh lines.  I will play the cards God gave me, and continue to wage conventional warfare against those untamed physical regions that seem immune to my best intentions.

Who knows, in the end, I may look back and find that the only real terrorist that existed in my life – – was my vanity.

Walk It Off

broken ankle
Image by freeparking via Flickr

“Pain is weakness leaving the body” – Tom Sobal

In 1000 AD England, King Elthred was supreme ruler on earth. To villagers and peasants, life was a fragile gossamer strand that could be snapped by a sudden invisible hand as easily as one might brush aside a spider’s web.

Healers relied on sacred and profane remedies to exorcise the physical demons that brought plagues and misery. In darker times, giving in meant giving up. People learned early to chide and cajole the injured and infirmed ( gettest thou out of bed, you are fine !) as if to acknowledge the severity of their condition would make it a self fulfilling prophesy.

In the late 1500’s, an unusual illustrated journal maintained by an 11th century monk revealed much about life and death in the dark ages. In one protracted pictograph of medieval medicine, leaches were applied to the legs of individuals with circulatory and psychological ailments.  With their parasitic poultice in tow, the afflicted were expected to walk great distances – presumably to increase circulation – which in turn would swell the growth of the leach until it would literally burst off the patient’s skin.  This bloody explosion was said to mark the point at which the bad blood had been extracted, improving the odds for a speedy recovery.  It was theorized by one etymologist that this was the genesis of the Anglican stiff upper lip expression – “walk it off.”

Centuries later, I recall being beaned in the right leg during a high school scrimmage by Jim Gott, an all-county pitcher who threw laser fastballs in excess of 90 mph.  Gott went on to enjoy a decade long career in Major League Baseball with stints as a reliever for the Blue Jays, Giants and Dodgers. On this day, he all but fractured my femur with a low and tight slider that chose not to break.  I am reminded of the blinding flash of pain as well as the taste of red dirt on my tongue as I writhed in the chalk of the batters box. I distinctly recollect the unsympathetic cacophony of fathers and coaches who all yelled out precisely at the same moment, “walk it off, Turpin!”

As I got up limping on one leg, I shot an indignant leer through the chain-linked backstop. I saw distain on their ancient faces and could almost divine their prehistoric thoughts.  “that kid, what a milk toast. “ and “It’s just as well his father isn’t hear to see this.”

Injuries were common in the era of free-range kids. There were road rash bicycle accidents, sandlot football broken arms, Fourth of July firework burns, and new scout knife gashes. We knew emergency room nurses on a first name basis. Yet these ladies only saw a fraction of our maladies as with most families of our generation, we used the “O Squared” method to triage medical events.  The O squared rule simply stated that one must have been bleeding from at least two orifices to merit professional medical attention. This therapeutic best practice was not unique to our family.  It was an indispensable axiom for our entire neighborhood including the Del Santo family, a classically prolific, eleven-kid Italian Catholic family that lived directly diagonal to our back yard.

The Dels kitchen was a 24-hour MASH hospital. I can distinctly recall one of the Del Santo boys breaking his finger and attempting to get treatment from Mrs. Del, a saint of a mother who, while holding a screaming child, cooking bacon and eggs and dragging two other toddlers attached to her ankles, adroitly administered a field dressing with the detached calm of a battlefield corpsman.

In a treatment torn from the page of a survivalist field manual, Mrs. Del grabbed a long plastic Lego, scotch tape and set the finger.  Both patient and parent seemed content with the makeshift splint although, I was personally stunned that the stopgap remedy became permanent and was never replaced with the popular metal splint encased in white gauze and athletic tape.

In the days of  “man up” medicine, athletic coaches did not get sued for pushing athletes to the point of heat exhaustion or vomiting. Having survived the Army with a crusty Master Sergeant who was the only survivor of a platoon overrun in North Korea, my father considered pain an essential process in forging stronger character.  Through suffering, one could achieve a higher plane of consciousness where pain ultimately subsided.  (We now know this higher plateau to be known as shock.) However, in the days of ” tough it out” and shake it off”, no one iced a monkey bump the size of a golf ball, paid attention to the bruise on your left quad that resembled the continent of Australia or woke you up every hour after taking a shot to the head in football.

It was not uncommon to come into the house balling uncontrollably after you had just pounded a nail through your hand while building a primitive fort or plunged an ice pick into your thigh while removing grout from shower. Parents of the 60s would actually hit you to calm you – perhaps influenced by war movies where the tough officer slaps the hysterically wounded man. ” Get a hold of yourself, Bob. You still have your other leg.” Once slapped out of your self-pity, your parent would proceed to pour stinging rubbing alcohol on your gaping wound causing you to shriek and leap uncontrollably out of your chair.  Another therapeutic slap reduced you to a drooling, blubbering, shaking mass of blood stained clothes.

In days before the over prescription of antibiotics created superbugs and killer staph infections, a boil would not be considered life threatening but instead be lanced with a sterilized sewing needle and protected with a simple 3 inch Band-Aid.  A summer splinter was dug out with that same needle as you were screaming, “ no, I can walk with this in my foot, no!”

One would think with this tough love education that we would have grown into a society of practical homeopaths eschewing formal medicine for crazy glue, anti-bacterial ointment and a rubber belt to bite on. As we became parents, we changed from Darwinian fatalists into empathetic hyperactive helicopter parents.  Actually, the opposite occurred.  At every sniffle, sneeze or throaty cough, we rushed our first-borns to emergency clinics and to pediatricians begging for antibiotics because we could not stand the uncertainty of an illness.  We wanted instant resolution and it contributed to creating a healthcare system that was all too eager to accommodate our anxieties.

As we got older and realized our children were more or less indestructible objects, we became part of the cavalcade of “ walk it off “ parents.  After our son fell while swinging on his pull up bar, we chastised him and sent him to bed – despite his complaints that his hand was hurting.  Two days later, he was diagnosed with a broken bone in his hand (ok, so maybe it was four days later).  Our daughter took a bad spill while playing soccer – again there was whining about a sore shoulder and neck.  “ You’re fine,” we told her as she complained about being too sore to practice.  Three days later we were looking at the X-Ray that revealed the broken collarbone. Oops!

It is a cool autumn football night as I wander over to midweek practice fields that buzz under an eerie glow reminiscent of alien landing lights.  There is a symphony of yells, whistles, smacking helmets and tribal clapping followed by a singular outburst  “break!”

A padded adolescent warrior lies on the ground and is slow getting up.  As players take a knee in a sign of solidarity, a coach sympathetically touches the players shoulder pad and coaxes him to sit up. Across the turf field, a father paces uneasily. His large build and slight limp suggest a lifetime of contact athletics.  I am secretly critical as he is obviously barely restraining his need to run on to the field to hold his son. He moves closer to the sideline straining to see his player, attempting to ascertain the nature of his injury.  As a veteran “ tough it out” parent, I start towards him to reassure him that his progeny will be fine.  He can hold it in no longer. Cupping his hands to his mouth, he screams,  “Come on Jimmy, you’re fine.  Get back in there!”

I feel a sudden chill and for a moment, sense my father is right behind me, seated on wooden bleachers urging me to suck it up and get back in the game.  I turn, expecting to see him restlessly pacing, waiting for me to dust myself off and hustle down to first base.

There is no one there.  As I turn to return to my observation post, I stumble over an equipment bag tossed on the sidelines and hit my knee on the gurf field.  Dusting myself off and limping over to the fence, I glance up hoping no one has witnessed my gaffe.  In the shadows lurks another late 40’s father.  He is obviously an alumnus of the “suck it up academy”.

“Walk it off, dude” he says with a chuckle.

Chronic

2D structure of eszopiclone (Lunesta)
Image via Wikipedia

 

Chronic

 

You take the blue pill, the story ends.  You wake up in your bed and you believe whatever you want to believe.  You take the red pill, you stay in wonderland.  And, I show you how deep the rabbit hole goes.  ~ Lawrence Fishburne, The Matrix 

Thirty years ago, chronic conditions were attributed to a much smaller subset of society.  People who had anxious limbs were encouraged to cut down on chocolate and caffeine, get more exercise and perhaps drink more water.  Drivers who became apoplectic at the reckless maneuvers of other drivers were “hot heads.”  People who experienced the occasional down day were considered to be feeling “blue.”  Older men needed to use the bathroom more frequently and people in high stress jobs often found themselves reading books at night, unable to fall asleep.    

It’s taken years for me to realize that I grew up chronically ill.  I had a short attention span, wiggled like a worm on a hook and wheezed when I ran, especially if I hadn’t exercised for weeks.  My penchant to eat too many cookies, tell lies when confronted with a punishment, forget to do my homework, chase girls, suffer the occasional nightmare and routinely punch my little brother when he bugged me – were all chronic conditions that went undiagnosed for years.  I do not have the heart to tell my parents that the punishments they meted out were visited upon a hopelessly sick child.  Thanks to Mike Adams of Natural News and the pharmaceutical industry, I now understand that I suffered from restless leg syndrome, attention deficit disorder, exercise-induced asthma, low blood sugar, chronic denial, irrational attraction, recurring hallucinogenesis, and periodic anger.  It’s a miracle I made it through elementary school.

The medieval treatment for many of these non-progressive conditions involved a leather strap around 36” long, applied vigorously to the afflicted child’s gluteus maximus until the symptoms ceased.  Other therapies were administered with open hands or common household implements.  Supplemental cures included total quarantine or gardening and the sanitation therapy of cleaning latrines. 

Physicians today are generally appalled at these methods, as we now know each of these conditions can be resolved with a prescription drug.  We now understand that our DNA strands are virtual Rosetta stones, revealing myriad predispositions to illness.  As we further explore this final frontier of divine programming, we rapidly develop drug therapies to arrest these genetic troublemakers in their tracks.  You can now travel to Canyon Ranch and, for a small fortune, identify genetic markers that indicate how you might metabolically respond to certain diets or drug therapies.  You can answer such nagging questions as “Am I more likely to respond to a low-fat or a low-carb diet?” and “On which psychotropic drug am I less inclined to gain weight?”  It’s all very uplifting.

While it is exciting to watch the evolution of genetic therapies lead to a next generation of “designer” drugs, we are also descending into an era of increased self-diagnosis – and an expanded definition of what it means to be “chronically ill.”

I can’t watch television anymore without seeing a luminescent butterfly gently raining pixie dust on an entire city of sleep deprived type A personalities.  They awaken after a fresh Lunesta induced sleep, rested and ready to operate heavy machinery.  The Flomax commercial makes me have to go to the bathroom.  I am jealous of these fishing, biking, and rafting crazies who spray each other with water and have not used the rest room in four days.  Going to the bathroom never seemed so fun.  High cholesterol and acid reflux ads show people eating pizza, cookie dough and possibly dirt while dropping their LDL lower than a Marin County vegetarian.  And there are the ads dealing with, well, how should I say, erectile dysfunction.  Everyone looks really, really…really happy.  The men are mischievous and the women are playfully coy.  The mood music is playing when suddenly, 50 of your closest friends drop in.  But don’t worry; you will be on your game, potentially for the next 20 hours.

As we enter the 21st century, we must not let up.  We must push for new therapies.  Research is already underway for the following progressive conditions:

• Combat Disassociation Disorder – CDC affects millions.  It is characterized by a complete disregard for the fact that your nation is at war.  Symptoms include lack of concentration on issues relating to foreign policy, energy or deficit spending.  In extreme cases, a CDC sufferer may attempt Richard Nixon impersonations.

• Situational Narcolepsy Syndrome – The drug industry hopes to eradicate this crippling condition that impacts one in two adult males worldwide.  To quote an industry insider, “The market for an SNS cure is huge!”  The condition is characterized by men absorbing less than 50% of information conveyed to them by their spouse or significant other.  In clinical trials, a combination of drug therapy and super amplified hearing aids has shown remarkable success.  A typical SNS sufferer might hear, “Honey, I need you to…Stamford…Johnny and Timmy…don’t forget…5 p.m.”  After clinical trials, the same respondent was able to absorb the following: “Honey, I need you to get to Stamford by 4:30 to pick up Johnny and Timmy.  Be sure to tell Carol that Timmy does not need a ride to soccer and call Sarah and tell her to walk to Starbucks at 5 p.m.  I will pick her up there.”

• Vicarious Delusion Syndrome – The Fairfield County Athletic Association has recently contributed venture capital to JSU (Just Shut Up) Biosolutions, a biotech research lab focusing on therapies to treat individuals who attempt to live vicariously through the athletic careers of their children.  VDS is characterized by fits of anger and limited peripheral vision.  Hearing is often impaired and public outbursts may be followed by periods of profound social and personal alienation.  Clinical trials have shown the experimental drug Justagame to work on the most advanced cases of VDS – parents who hang out at the local fields even when they have no children playing. 

Thankfully, our friends in the biotech and pharma industries are hard at work to attack these and other illnesses.  Imagine a future of malleable teenagers, attentive spouses, cooperative coaches and civilized spectators.  Consider a life where you can sit through an entire episode of The Hills with your teenager without feeling nauseated. 

It’s just around the corner, and I can’t wait.  In the meantime, I will have to deal with anxiety, uncertainty, stress and anger the old fashioned way – through exercise, traditional medications and eating right.  Tomorrow can’t get here soon enough for me.  Actually, I’ve been told my constant preoccupation with the future is an undiagnosed case of Random Anticipatory Anxiety Syndrome; soon it, too, will be treated. 

Better living through modern chemistry. Thank heavens!