Friday, December 17, 2010

Story Time: Twas A Week Before Christmas

Forgive me for pulling out another Alaska-themed tale, but the timing for this one is perfect: this time of year nineteen years ago I made my move west and north and it makes for a pretty good story.

Fresh-faced, black-haired, and naive, the wanderlust I spoke of in a previous post had taken hold and I accepted a job offer in Chugiak, which is outside of Anchorage. Preparations included getting Lynne's Jeep Grand Cherokee tuned up and having the transmission replaced. The West Virginia inbred who repaired the car installed the wrong transfer case and I had no four-wheel drive the entire trip, though was blissfully ignorant of this fact for most of it. Front seats were moved all the way forward to allow the back of the car to be filled with various possessions (mostly milk crates stuffed with books, if I recall), forcing me to drive knees to chest across the continent. A plastic clam-shell secured to the roof filled with what wouldn't fit inside added aerodynamic style. To save money, of which I had little, the passenger seat held a cooler packed with trail mix and jerky. My gastrointestinal system still holds a grudge over
that decision. For entertainment, my buddy Gary gave me a stack of cassette tapes of various comedians--Gary Shandling, Robin Williams, Robert Klein--invaluable during those long stretches where the only radio signal was from some Children-Of-The-Corn community in the American outback. Gary would continue to abate my homesickness by sending tapes of the Howard Stern Show to Chugiak. That my friends, is a true friend. My last act before leaving was to put an engagement ring on Lynne's finger. To this day I'm unsure if this was a gesture of commitment or a male marking his territory. Either way, it was apparently the right move because I've somehow managed to hold onto that little jewel ever since.

Day 1: Fairfax, VA to Altus, OK (1,456 miles)
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Coffee is a miracle. A full 24 hours of driving the first day. True, I was fueled by excitement as well as caffeine, but it still made for a long first leg. Looking at a map, you'll notice that this is not the straightest distance between two points. There was a method to this madness. My friend Matt worked for the Air Force at Altus and had a free place to crash and grab a meal or two (did I mention how small my travel budget was?). In the end, I spent most of my time there in bed, moving on shortly after waking, but his was the last familiar face I'd see for almost a year.

Day 2: Altus, OK to Salt Lake City, UT (1,045 miles)

Aside from a free night's stay, going through Oklahoma also set me up to cross the Rockies near Albuquerque, something I thought might be best in late December. As it turned out, I hit an ice-storm in the Texas panhandle and drove through a fog in Utah that turned to ice on the windshield faster than the defroster could melt it. I drove a winding canyon road hunched over, navigating through the clear spot just over the defroster vent. When I finally found a cheap dive of a hotel on the outskirts of Salt Lake I was exhausted. I hated spending money on a room I would only be in for about six hours, but it was way too cold to chance sleeping in the car.

Day 3: Salt lake City, UT to Bellingham, WA (924 miles)

Woohoo! A sub-thousand mile day! I was in a groove now. My ass was conforming to the car seat (or vise-versa) and the miles seemed to fly by. Things got interesting going over
Snoqualmie Pass in Washington. See, to this Virginia boy, the word "pass" conjures up visions of a low spot in the mountains where cars can pass freely in all seasons. The concept that a pass might actually close due to weather was beyond me. My AAA TripTik had no elevation markings, just a blue-highlighted I-90 that seemed to shout "clear sailing, by Jove that's a pass up ahead". I found myself in a blizzard, semis splattering my windshield with dirty snow. Cleaning fluid ran dry. It was then, trying in vain to see lane lines through a muddy smear, I realized, not for the last time, that I might be in a bit over my head.

Fortunately, on the other side of the pass snow turned to rain, which allowed for better visibility and a chance to get off the highway and replenish my washer fluid. From there it was a wet, but easy drive to Bellingham. The next day I would be headed over the Canadian border for my date with the AlCan Highway.

Day 4: Bellingham, WA to Dawson's Creek, British Columbia, Canada (722 miles)
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Slept in for the first time and was well rested crossing the border, with more than a few suspicious looks from the officers there. Sure, I
said I was moving to Alaska, but I had a car packed to the roof with all my stuff. Who would know if decided to find myself a cozy little town in the interior and become a Canuck? The drive on this stretch was not as easy going and fast, but the British Columbia scenery was fantastic, and I started to see the first wildlife of the trip, stopping to let a herd of Bighorn Sheep cross the road. (the pictures here were taken with a disposable camera almost two decades ago and scanned, so no cracks about the photography!). Across Canada I would see caribou, moose, bison, fox, lynx, and even a lone wolf on or along the road. There are definite benefits to driving dawn to dusk with almost no traffic on the road.

Day 5: Dawson's Creek, BC to Watson Lake, Yukon Territory, Canada (967 miles)
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Getting pretty far north now and the scenery was white and desolate, but no less beautiful for it. The road was now a line of packed snow and the distances between services so long I had to consult my Milepost to be sure I didn't pass up a chance for gas and get stranded in the Yukon like some character out of a Jack London story. The trip was wearing on me now, no doubt about it. The lack of sleep, the poor food, the concentration of driving on snow. You can hear a stand-up routine only so many times before the jokes get old (the official number is three, like a Tootsie Pop). By now I had figured out that there was something going on with the four-wheel drive. I had slid off the road, trying to stop too quickly to get a picture of a moose (by the end of the trip, seeing moose was such a common occurrence it barely raised an eyebrow) and had to get towed off the shoulder and back onto the road by some helpful locals. The Jeep wasn't in deep snow, so this was surprising, but i wasn't about to stop and try to figure it out--not that I could have done anything about it anyway. Future wildlife sightings were handled with much less enthusiasm--stopping in the middle of the "highway" was not an issue when you rarely saw half a dozen other cars in a day anyway!

Day 6: Watson Lake, Yukon Territory to Tok, Alaska (1,058 miles)
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USA! USA! Christmas Eve spent on a fourteen-hour marathon drive just so I could get across the border. I was able to find one hotel still open in Tok (it might have been the
only hotel in Tok, now that I think about it). The room had no phone, only a small tv with antenna reception. In the cliche of cliches, on the one grainy channel that was viewable, the thing playing when I checked in was--you guessed it--It's A Wonderful Life. I called both Lynne and my family collect from the phone booth in the parking lot, shivering so badly from cold I cut both conversations short and ran back to the warmth of the hotel. My room was tiny and dirty and I slept fully clothed on top of the threadbare comforter. I was very depressed and lay there wondering if I had made a terrible decision.

Day 6.5: Tok, AK to Chugiak, AK (303 miles)

Morning didn't start out much better. It almost didn't start at all. The first turn of the key produced a weak "rrrrrroww" sound under the hood. Ugh. Of course. Too cold for the engine block. Second try: "rrrrrrow". On the fifth it started, I breathed a sigh of relief and was on my last, short sprint to the end. I had some money in my pocket and treated myself to a Christmas breakfast at a diner along the way. As is typical throughout the state, portions are of a size befitting Alaska itself and I gorged on pancakes, eggs and sausage. It was a cold, clear, gorgeous day and between the weather and the food, my dark mood lifted away. I sat at the counter next to a trapper. No, I mean it. An honest to God guy who made his living setting a trap line and checking it every day on his snowmobile. No electricity at the house except via gas generator which they fired up on Christmas to light the tree. Fascinating to talk with and the conversation renewed the sense of wonder this adventure had produced at the beginning. I pulled into my new job late in the afternoon, 6000-plus miles and a week after leaving Virginia. What more could a boy ask of Christmas?

Friday, December 3, 2010

The Big C

Cancer sucks. I've procrastinated writing this entry because it's a very personal subject, as I'm sure it will be to many readers. My grandmother died at a very young age from colon cancer. I lost a dog to liver cancer a few short years ago, and of course have lost many wonderful patients to cancer over my career. But it's an important subject, and I felt it would be good to blog about since it affects so many people and animals, so here goes:


Traditional Chinese medicine looks at cancer in an interesting way. In a healthy body, qi and blood circulate through the meridians and imbue movement, nourishment, strength, and vitality to an animal. (For more on Chinese theory, please see the articles in the Services section on
acupuncture and herbal medicine) Cancer begins with the accummulaion of an abnormal substance roughly translated as "phlegm" in English. Phlegm can be thought of as energetic fly-paper: sticky, goopy stuff that accumulates within the body and interrupts normal function. It can be carried through the body, lodge in a meridian and block the flow of energy, causing heart attacks and strokes, or it can act in a more subtle way. As qi and blood course through the body they can be grabbed by phlegm, like fly-paper or a spiderweb ensnares a passing fly. As qi and blood continue pass by more of these energies are trapped and accumulate, eventually tangling together. I envision it like a snarled fishing line; the more line you feed it, the bigger it gets. (Yes, I am the King of Simile). This tangle grows until we appreciate it as a mass, and just like fishing line is a bear to undo once started.

So what creates this phlegm in the first place? If I knew the answer to that in every case, the rest would be easy. Certainly things that damage normal function, like toxins and viruses, are culprits. Aging animals also create phlegm as the body becomes less efficient and waste products build up. Food plays a big role. We know that certain foods are likely to produce more phlegm in the body than others. In carnivores like dogs and cats high carbohydrate loads, commonly found in processed kibble and grains are factors that lead to phlegm. Dairy is another. Herbivores are another matter, they have a higher tolerance for grains and carbohydrates, though excessive sugars like molasses can lead to problems in them as well. Perhaps a better way to look at food is that the feeding of a
species-inappropriate diet leads to phlegm accumulation. With this perspective, maybe we can look at high cancer rates in dogs and cats as opposed to the relatively low occurence in horses as being correlated to the types of food we put into their bodies. Which species is being fed closer to their optimal evolutionary diet? Dogs? Hardly. How often would a wild canine come across, and eat, any grains? Horses, especially those being fed high levels of hay and grass and little grain at least approximate a wild equine diet. And yet, there are dogs out there (I know, I see them all the time) fed fantastic raw food or home-cooked diets and still get cancer. Why?

Part of the answer lies in an individual's constitution, or genetics, to put a more modern spin on it. Hang around dogs long enough, you'll find certain breeds have a much higher predilection for cancer: Golden Retrievers and Boxers are two that come to mind. One thing that most of the individuals of these breeds have in common would be their constitution, as defined in Chinese medicine. We consider these animals a Fire constitution, and they are characterized by their exuberent friendliness, energy, and overall joyful and happy personalities.

With Fire we think of heat, and indeed, these breeds are prone to many other diseases with heat at their core: allergies, inflammatory bowel disease, and ear infections, to name a few. Chronic heat may also lead to cancer. Think of it this way: if you want to reduce a sauce to something thicker, you leave the pan on the heat for longer, right? Phlegm can manifest in the same fashion: heat, over time, thickens normal fluids in the body until they become a more dense, stickier substance which eventually transforms into phlegm, which in turn has potential to start the cancer-tangle. Of course, not every Fire individual will get cancer, but in some individuals, this constitution is so strong that they may overcome one type of cancer only to succumb to a wholly different tumor down the road.


The first bit of advice I give to people who have an animal with cancer is
"Get Ye to an oncologist". This is not to say that I have nothing to offer, simply that in most cases Western medicine has a better answer, and when time is of the essence better is, well, better. Chemotherapy, radiation, and even surgery offer faster and more aggressive treatments, an approach more likely to garner results in the short term. There has been great advancement in veterinary oncology in the last couple of decades, to the great benefit of patients. The down side to these therapies is that they can be expensive, they may not gain as much additional time as we would like, and they sometimes result in side effects that make you wonder if the time gained is of worthwhile quality. So where does Chinese medicine fit in?

Personally, I like the integrative approach. Now "integrative" may be the latest catch phrase, along with complimentary, comprehensive, and mixed medicine; all ways of saying "let's throw everything at this case and hope something sticks." Actually, that's not as bad as it sounds, because often something
does stick, leading both oncologists and alternative practitioners to claim credit, in spite of all that other nonsense that was tried. When chemo, radiation, or surgery is opted for I'm more than happy to sit on the bench and use herbs to treat side effects like nausea, diarrhea, or loss of energy. Herbs can treat the anemia that results from many chemotherapy regimens or help with healing and pain relief after surgery. Once patients are through their primary treatment, additional herbs can be used for fighting cancer and keeping it in remission.

What if an animal is too fragile for aggressive treatment, or the treatment is too expensive, or a patient has severe enough side effects that treatment needs to be discontinued? Well, in these cases herbs can be used alone. This is done in a stepwise approach. First we spend time, sometimes weeks, using herbs that "untangle" blood and qi, get phlegm out of the body, and break down the mass. This might include herbs like
San Qi (pseudoginseng), Tian Nan Xing (arisaema), Qing Dai (indigo), or Hong Hua (safflower). After a time, the herb mixture is changed to do less untangling and more breaking; this is when tumors might actually shrink. It is also the time when acupuncture might come into the mix. There are different views on using acupuncture to treating cancer patients. My own is that it should be avoided in the initial stages of treatment, because acupuncture can strongly move qi and blood, and if the tangle is tight there is a good chance of feeding into the tumor and accelerating the disease. In my mind, once a formula has changed to focus more on breaking down a mass, then acupuncture is more appropriate. Herbs used to fight cancer are strong, and can cause side effects similar to chemotherapy, though not usually as severe, so delicate patients are less likely to be at risk of harm.

There are, of course, cases that are impossible to cure, or even slow the progress of, the disease. In these patients, herbs are chosen to help make whatever time is left as comfortable as possible. A real-life example is a dog I saw about ten years ago, an older German Shepherd riddled with lung cancer. Now, as is often the case, this dog showed no outward sign of being ill until he had only a few weeks to live. All of a sudden he was lethargic, anorexic, and generally miserable. His owners were a bit shell-shocked and not ready to say goodbye. We came up with a mixture of herbs that perked him up, allowing him to resume the nightly walks he so enjoyed, and got his appetite back on track. He didn't live but another two weeks, but in that time he was happy, and it allowed his family to come to grips with his passing and spoil him rotten in the meantime, and it allowed this dog to enjoy himself for a while longer. It felt really good to be able to do this for both the dog and his people.

Yes, cancer sucks, and there is no magic in Chinese medicine, just as there is no magic in Western medicine. We do what we can, hope for the best, and pray that in the end we did right by our patients.

In Memory Of Barclay

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