Reflections on Mortality, Part 3: Illness, (and Worry Revisited) (9/25/24)

(As I review this in July 2025, I broke this down into three segments to make it more digestible!  Since now being diagnosed with Parkinson’s disease, in retrospect, many things make more sense.)

 

 

A physician who treats himself has a fool for a patient!

Sir William Osler

 

My mother died of pancreatic cancer at age 65.  Her father also died of pancreatic cancer, as did his brother!  (And just last month, June 2025, my mom’s sister also died of pancreatic cancer.) This specter floats in the back of my mind!

 

When I was in my early 60’s, I visited my cousin, who was dying of esophageal cancer, at age 65.  His mother, the youngest sibling of my grandfather who died of pancreatic cancer remarked about the apparent curse on the Machnauer firstborns who died of cancer at age 65 (her son, my mother, my mother’s father).  I was the firstborn, and had 65 in the near future!  I am now 67, so I beat the curse, but did have that rolling around my memory for a time!

 

In medicine, we have some tools we use to diagnose patients.  These include the history and physical exam, where we gather information, which we then put together into possible scenarios, which we call a differential diagnosis.  It is much like playing the murder mystery board game Clue.  Instead of Colonel Mustard in the ballroom with the wrench, we come up with various possibilities which we check out by ordering various tests and procedures.  Usually, we rank the order of these by likelihood, but sometimes approach them by level of urgency.  Maybe it is not the most likely, but is the most life threatening, so it needs ruled out first.

 

These tools, when thoroughly utilized, provide an efficient, cost-effective approach to helping our patients.  But they can be a bit of a curse when applied personally.

There have been a few times when I have allowed my doctor knowledge to be applied to my personal health.  There have been times when I have had prolonged mid back pain that I couldn’t explain via my level of physical activity.  I couldn’t help but wonder if something was brewing in my pancreas!  When I had constipation, bloating and abdominal pain (which was due to the medicine for bladder spasms) I began thinking about possibilities, with the side effect from the medication not even being on my list!  In these cases, sometimes I have started down the path, if it is pancreatic cancer, then… (Worry?)

 

Currently, I am walking down that pathway again.  I have developed a tremor in my right hand.  Actually, the term is clonus, rather than tremor.  I noticed that when brushing my teeth, my hand kept moving when I was done brushing.  How curious!  I did what I caution my patients about doing, I went to the Internet!  As I formed my differential diagnosis, I began pulling in other pieces of information that might be related.  

 

About 4 years ago, I developed bladder spasms, which were attributed to swelling of the prostate gland. About 9 months ago, something popped in my neck which caused significant spasm and pain in my neck and upper back, that slowly resolved over time but left me with a limited range of motion in my neck.  A year and a half ago I was evaluated for fatigue in my legs.  I noticed that I was not able to keep up with my wife on our E-bicycles without dialing in more assist power.  Prior, I had been the stronger rider.  I also have some gait clumsiness, which I attributed to my multiple foot surgeries.

 

Then, a few months ago, as my 3 ½ year old grandson was learning to do somersaults, I thought I would show him how.  Again, the neck and back pain and spasm recurred.  I also noticed that the tremor was beginning in my left hand and right leg.  There are other symptoms as well, but I can’t help but wonder if some of these are real, or simply an invention of my imagination.  My arms and legs do feel heavy and fatigued, and my hands seem clumsy.

 

I did go to my primary care doctor, not wanting to be my own doctor, but found it difficult to refrain from steering the process a bit.  On top of my differential diagnosis was spinal stenosis in my neck, a narrowing caused by arthritic changes, putting pressure on the spinal cord, which could account for the majority of the symptoms.  And indeed, spinal stenosis was identified in the neck!  I began going down the path, planning for a surgery to fix the problem.

 

When I finally got in to see the neurosurgeon’s nurse practitioner for an evaluation (rather than the surgeon!  Part of the new, more “efficient” medical factory system), she said that the spinal cords and nerves did not show pressure changes that would account for the symptoms.  So, now I head for the neurologist and more testing. 

 

Since then, I am now noticing symptoms in my face as well, which would not likely be caused by pressure in my neck!

 

So, rearranging my differential diagnosis leaves me looking at some daunting diagnoses, such as ALS (amyotrophic lateral sclerosis, aka Lou Gehrig’s disease).

 

I see the neurologist next week, but I have already gone down the path of “What if…?”  Questions like, “Feeding tube? Ventilator? Home care?...”  Also, “Is it time to retire? Clean out the attic and garage? Rearrange finances?...”  

 

I am not really afraid to die.  Actually, I am looking forward to the next life!  But, I am not too keen on the process.  I’d like to be around a bit longer to be involved in the lives of my grandchildren. 

 

So I find myself cogitating (worrying?) about this throughout the day.  I keep telling myself, “Wait and see what the neurologist finds.  This is not my area of expertise.  It may be another ‘false alarm’ on which I am spending too much time and energy.  I am allowing myself to be so preoccupied with this that I am failing to live now!”

 

So as I wrestle with my thoughts, turn the worries over to Jesus, and seek to make the most of today, I thought journaling might be helpful.  Thus, this.