Random Cancer Thoughts

Pancreaticcancerawareness160left
Several people have mentioned via email and in comments in these pages on their own experiences with cancer, that theirs is a small thing compared to my pancreatic cancer.

Are you guys kidding? It says something about the state of the science in regard to almost all cancers that it is just about the scariest diagnosis anyone can get. Not that there aren't other diseases of age that are equally fraught but we are culturally conditioned to more or less freak out when cancer is mentioned.

I recall thinking when I was quite young, in my twenties I suppose, that I wouldn't need to worry about cancer because it mostly affects old people and by the time I got there, surely science would have learned how to prevent or cure it.

Yes. Well. It didn't work out that way. But I wonder if people of our age expected it to have been so because science was so successful in the 20th century creating vaccines for most of the diseases of childhood: measles, mumps, chicken pox, small pox, diphtheria, whooping cough, polio, etc.

That happened in our lifetimes and is an astonishing achievement – moreso for those of us old enough to remember quarantine signs on homes of neighbors afflicted with one of those diseases before the vaccine was created.

4-early-20th-century-quarantine-sign-everett

My point, however, is that no one's life-threatening disease is better or worse than another person's. Besides the disease and the (sometimes awful) treatment, we bring our personal histories to these frightening events, our hopes and fears, our spiritual beliefs or lack thereof.

All these and more affect how we face frightening events which therefore cannot, nor should not be compared one to another.

CHEMOTHERAPY AND SOCIAL WORKERS
A social worker connected with the clinic where I will receive my chemotherapy treatments telephoned to discuss what her department can do for me.

She said that they are there to help with just about any practical or emotional issues that come up – that over the years, they have seen pretty much everything from something as simple (to them) as arranging transportation to prescriptions, often anti-anxiety medications.

Until she mentioned that last item, I hadn't realized how important it is to me to feel what I feel and how adamant I am about it.

As I mentioned last week, I have good days and bad days but I see both as learning opportunities and it has been my experience throughout my life that almost always the bad times, painful as they can be, are more enlightening than good times, as enjoyable and important as the latter kind are.

POST-WHIPPLE PROCEDURE DIET
Healthy eating is deeply embedded in my daily life. Not that I don't indulge in ice cream now and then but generally, I eat mounds of vegetables and fruit along with fish, seafood and very occasionally, lamb – my favorite of the red meats; I don't miss the others.

Then, along came the Whipple Procedure during which they removed a good portion of my pancreas. Since then, my pancreas does not create enough of the enzymes that are required to digest food properly and I must take a pill to replace those enzymes with every meal.

As it turns out, that's the easy part.

Almost all vegetables – at least for the time being – are verboten for their high fiber content. I'm making sandwiches with white bread now, no whole grains allowed.

I'd been worried about the lack of green things in my diet until I discovered that certain lettuces, cucumbers and zucchini among a few others are low fiber although I need to peel the latter two to keep the fiber content as low as possible.

Most fruit is okay as long as they are peeled too, except, as a nurse noted to me, for grapes and cherries (in high season now and at their best) should be avoided because they are damned hard to peel.

Protein is important so that foods I ate sparingly in the past because of their high calorie count are now essential: peanut butter, cheeses, pasta – but the white kind, not whole grain.

A danger with cancer and the Whipple is weight loss so I am also encouraged to eat anything that is high in calories – ice cream is no longer a no-no but here's the rub: I'm hardly ever hungry and have to force feed every meal. By the time I get to dessert, two or three spoons of ice cream is all I can handle. (This from a woman who, until two months ago, believed a serving of ice cream is a pint.)

There is more but you get the idea.

My entire way of eating has been upended. It is more important right now to allow foods high in calories and avoid those that are hard to digest. I'm still learning how to cook this new way and have not ventured out to a restaurant yet.


Inequities in Elder Healthcare and Myths About Older Drivers

Two important topics in the realm of ageing that I bang on about from time to time turned up in separate, well-researched articles last week and both are important to elders, their families, people who care for them and to public policy. Let's take them one at a time.

OLD PEOPLE ARE NOWHERE NEAR ALL THE SAME
And this produces profound inequities in their healthcare compared to children and adults.

Writing in The New York Times yesterday, Louise Aronson, a professor of geriatrics at the University of California, San Francisco, points out that in the U.S. healthcare system,

”There are 17 subgroupings for children from birth through age 18. That makes sense because, of course, a 6-month-old has had little time to develop immunity, weighs far less than an 8-year-old and is exposed to fewer people than a teenager.

“There are five subgroups for adults. But all Americans 65 and older — including the two fastest-growing segments of our population, the 80- to 90-year-olds and those over 100 — are lumped in a single group, as if bodies and behaviors don’t change over the last half-century of life.

“You don’t need to be a doctor to see that this is absurd.”

Gty_flu_vaccine_lpl_121120_wmain

Although Professor Aronson's Op-Ed is specifically about vaccines, she makes it clear that not differentiating between the young-old and old-old makes all healthcare for elders questionable. Studies have shown, Aronson writes, that some common procedures in urological conditions, acute myeloid leukemia and chemotherapy treatment have much less efficacy in older patients.

”There are simply different risk-benefit ratios for older adults; the frailest and oldest often incur all the immediate harms of treatments, from prevention to intensive care, without seeing the benefits.

The sad fact is that we frequently don’t know how to best care for the old. Treatments rarely target older adults’ particular physiology, and the old are typically excluded from clinical studies.

“Sometimes they are kept out based on age alone, but more often it’s because they have one of the diseases that typically accompany old age. And yet we still end up basing older people’s treatment on this research, because too often it is all we have.”

Hear, hear - the inequities are obvious and can be deadly. Aronson concludes:

”In the 20th century, vaccines conquered many of the deadliest diseases of childhood. In the 21st century, when the number of older adults will surpass the number of children worldwide, we need to similarly target oldhood...

“Life is a three-act play. It’s time our medical system reflected that truth.”

No kidding.

MYTHS ABOUT OLDER DRIVERS
Many states have different driving license requirements for people 65 and older. Among the most common, according to ClaimsJournal website in 2012:

Must renew more frequently, from one to five years, in person only and pass a vision test

Require an optometrist's certification for vision or a doctor's certification that the driver is medically fit

A few states require a road test each renewal

Some states allow health providers, family and in one case even neighbors to report what they believe are impairments to driving

OlderDriver

These restrictions on renewals for older drivers have been increasing in recent years because it is widely believed, and hardly ever challenged, that old people cause more accidents than younger drivers.

That is simply not true as Cynthia Kuster, an elder care attorney with the law firm Lamson & Cutner recently reported from her research. Some excerpts:

”Let’s start with question a) – DO elderly drivers pose an increased risk to others?', writes Kuster. The short answer is: Not really.

“Even at their highest rate (for drivers 85 and older), the fatality rate for accidents caused by seniors is the same or lower than that for drivers 25 years old and under. The data indicate that even through the age of 84, older drivers caused fatalities to occupants of other vehicles and non-motorists at about the rate that 30-year-olds do.

“That is simply not a major danger. We’re certainly not stopping 30-year-olds from driving, and drivers younger than 30 are far more likely to cause the death of others than are 84-year-olds.”

As to whether old drivers are a danger to themselves, Kuster tells us that when the driver is at fault, a 76-year-old is as likely to die in an accident as a 26-year-old. But after age 83, driver fatalities rise significantly.

”However, the AAA study I looked at here cites a study, published in the Traffic Injury Prevention journal, that found that increased fatalities in elderly drivers are more common because the drivers are frailer, and injuries sustained in an accident are much more likely to result in death than they would be, were the driver younger.”

As Kuster concludes:

”The AAA study summary states, 'Relative to other age groups, drivers aged 85 and older face the highest risk of their own death, whereas teens pose the greatest risk to passengers, occupants of other vehicles, and non-motorists.

“The Traffic Injury Prevention study cited in the AAA article stated: 'Older driver motor vehicle crashes are not a significant threat to other road users in vehicles or as pedestrians...”

“Focusing on how to make driving safer for seniors – or more importantly, how to make crashing less deadly for them – should be a focus of public safety advocates.”

As the first article above notes and as I have reported here for years, elders age at different rates. An individual 60-year-old may show dramatic signs of incapacity while an individual 80-year-old may not.

We each are reponsible to monitor our vision, reaction times and confidence behind the wheel and long before hanging up the keys, figure out how we will get around without a car.

Until then, don't let anyone tell you elders are worse drivers than younger people. Not to mention that There is more than a little ageism involved in each of these two issues.


ELDER MUSIC: 1961 Yet Again

Tibbles1SM100x130This Sunday Elder Music column was launched in December of 2008. By May of the following year, one commenter, Peter Tibbles, had added so much knowledge and value to my poor attempts at musical presentations that I asked him to take over the column. He's been here each week ever since delighting us with his astonishing grasp of just about everything musical, his humor and sense of fun. You can read Peter's bio here and find links to all his columns here.

* * *

There's a truism that the period between Buddy Holly dying, Elvis going into the army, Chuck Berry going to jail, Little Richard finding religion, Jerry Lee Lewis marrying his 13 year old cousin and the rise of the Beatles, Bob Dylan and the rest was a musical wasteland.

Today's column will put paid to that in no uncertain terms. Of course, I might be biased as this was the music that was around when I was in my mid-teens, the time when that sort of thing gets seriously imprinted on one's brain.

There's no better way to start the year than with the incomparable BEN E KING.

Ben E King

Ben first came to my notice as the lead singer of the Drifters. He then had a successful solo career. One of his first hits was one of the finest songs from that time, Spanish Harlem.

It was written by written by Jerry Leiber and Phil Spector and produced by Jerry and his usual writing partner Mike Stoller, not by Spector who was more noted as a producer than a song writer (if you can follow all that).

♫ Ben E King - Spanish Harlem


Another great singer from the period is GENE MCDANIELS.

Gene McDaniels

Gene started out as a jazz singer and that's where he ended up. However, around this time he was persuaded to sing some pop songs. Naturally, he did them better than most of the other singers who were around at the time. This is one of his big hits, Tower of Strength.

♫ Gene McDaniels - Tower of Strength


The Beatles had a big hit with this next song, but THE MARVELETTES did it first and did it better.

The Marvelettes

They had other songs that made the charts but the one for which they are most remembered is Please, Mr. Postman.

♫ The Marvelettes - Please Mr. Postman


CURTIS LEE left his native Arizona and went to New York to break into the music industry.

Curtis Lee

He initially found a little success writing songs with Tommy Boyce (who later became hugely successful in that area with his later writing partner Bobby Hart). Curtis recorded some songs under the direction of Phil Spector that became hits.

Later, without Phil's direction, the hits dried up and Curtis left the music biz. One of his biggies is Pretty Little Angel Eyes.

♫ Curtis Lee - Pretty Little Angel Eyes


FLOYD CRAMER was the go-to man whenever a pianist was needed on a country music recording.

Floyd Cramer

Floyd also recorded a few tracks himself, some of which made the charts. This is one such, an instrumental called On the Rebound. He had a distinctive style and you could always tell when he was present on a record. He was one of the great studio musicians.

♫ Floyd Cramer - On The Rebound


Billy CRASH CRADDOCK was a huge success in Australia, much more so than in his native country.

Crash Cradock

Because of that he toured here often. He later became a successful country singer but he will always be remembered in Oz for his many hits from the time. One of those is One Last Kiss. Bobby Vee was another who made the charts with this one.

♫ Crash Craddock - One Last Kiss


CLARENCE (FROGMAN) HENRY is another fine musician from New Orleans.

Clarence Frogman Henry

His first hit, Ain't Got No Home, was essentially improvised in the recording studio. It was from that song that he gained his nickname. He later toured with The Beatles. After all that he had his own club in New Orleans where he'd perform now and then.

He still appears in festivals (as of the writing of this column). A song of his from 1961 is But I Do, written by Bobby Charles.

♫ Clarence (Frogman) Henry - But I Do


My goodness, ADAM WADE had a great voice. Still does, as far as I can tell.

Adam Wade

Adam started out as a lab assistant to Jonas Salk on the polio research team. He left that to pursue a career in music. He had a number of hits around this time and later turned to television and films. One from this year is Take Good Care of Her.

♫ Adam Wade - Take Good Care Of her


I'm rather surprised that I didn't include this next song in either of the previous incarnations of 1961. I'm going to correct that oversight with THE SHIRELLES.

The Shirelles

I'm also talking about their biggest hit, at least it was around where I lived. I've always put them at the top of my list of female singing groups from the time. Will You Love Me Tomorrow?

♫ The Shirelles - Will You Love Me Tomorrow


I don't know if EDEN KANE was known in America, but he had a major success in both Britain and Australia with the song Well I Ask You.

Eden Kane

Eden was born in India and both his parents were classically trained musicians. He had two older brothers (Peter and Clive Sarstedt) with whom he also collaborated. Peter also had success with the song Where Do You Go to (My Lovely).

Eden (real name Richard Sarstedt) was the first of the brothers to hit the pop charts with this song.

♫ Eden Kane - Well I Ask You


I have a bonus track. Quite some time ago I rediscovered a song from my past, one I hadn't heard or thought about for decades, and thought, "Oh, I have to include that in a column". I found that it was from 1961 and as I hadn't created a third incarnation of the year at the time, that'd be where I would put it.

Time passed and I remembered that I was going to produce a 1961 column but I had forgotten about the catalyst for it. It was only later when I finished that I remembered.

Rather than throw something out, I've included it as an extra. Now, once you hear what it is, you might wonder why I bothered. That's 1961 for you. Here is PAUL EVANS with Show Folk.

Paul Evans

♫ Paul Evans - Show Folk



My Introduction to Chemotherapy

Pancreaticcancerawareness160leftWhat interesting, useful and fruitful discussions you - TGB readers - have been carrying on in the comments of posts about my pancreatic cancer. Some of you have been-there-done-that with a variety of cancers and I appreciate your generosity in sharing your experiences – it enriches our understanding.

On Wednesday, I met with the medical oncologist and her team to talk about my upcoming chemo. I had been dreading the meeting since it was booked a few weeks ago.

Despite what you think from my written reports here, my upbeat, optimistic days run parallel with dark, pessimistic, even frightening ones that include horrible images that appear unbidden as I am falling asleep at night or for an afternoon nap.

My mood worsened in the days leading up to Wednesday's meeting with memories of how chemo sickened my father and wasted his body 35 years ago, which I tried to counter with the success my friend Joyce Wadler had with chemo through three different cancers.

It didn't help much and even though I told myself that there was no point in having gone through the terrible recovery period from the Whipple procedure surgery and not follow up with the recommended chemo was just stupid, my gloom persisted.

“Stupid” is the word since, as the experts keep telling me, I am in better shape to beat this cancer than 90-plus percent of patients. To recap:

Because most pancreatic cancer is detected after it has spread, only ten percent of people diagnosed are eligible for the surgery.

The portion of my pancreas that was removed, including the tumor, was “clean at the margins” meaning it has not spread from that organ.

In addition, 17 lymph nodes touching the pancreas were removed and tested for cancer cells; three were positive.

Eighty percent of patients in my circumstance who take the chemotherapy are dead from the disease in five or fewer years.

And you wonder why I'm sometimes morose about this?

On the other hand, there is what my primary care physician said when I saw him a couple of weeks ago: “Ronni, you are very healthy - except for the cancer.” Maybe that is what made the medical oncologist on Wednesday more upbeat about my chemo outcome than some others: that it will be “curative” which means, like many other cancers, it is considered cured if the patient is cancer-free in five years.

To know that, there will need to be regular checkups, tests and scans to monitor the cancer (or – best case scenario – lack thereof) which, of course, leaves me with the life I have always wanted to avoid: being a professional patient.

But what other choice is there? So in mid-September I will begin chemotherapy with two drugs – one intravenous weekly through a port permanently embedded (for the duration) in my chest, and the second drug taken orally twice a day every day, each for three weeks in a row, then a week off before starting again.

For six months this goes on which will take me to March 2018. There are, of course, potential side effects – fatigue, various kinds of sores, peeling and cracking skin but not, in my case, hair loss, or not much they say.

With the intravenous drug alone, 55-60 percent of patients are alive after three years, the medical oncologist tells me. When the second, oral drug, which is relatively new, is included that number is increased by 15-plus percent.

That's the good news. The bad news is that the cancer might come back, usually in the liver or lungs and there is little treatment then.

Those of you who have discussed your chemotherapy in the comments undoubtedly know all about this with whatever differences apply to your kind of cancer.

To me, this is all new and in my gloom, I sometimes lean toward agreeing with those people who renounce these “poisons” in favor of herbs and other “natural” treatments.

My more rational self knows perfectly well that if flax seeds cured cancer we would have heard about it and they would cost $5000 an ounce.

Like me, you have probably noticed through the years, that people are remarkably adaptable to difficult even, sometimes, severe circumstances and once I get started with this new weekly routine in mid-September, I'm sure it won't feel as burdensome as it does now.

* * *

ABOUT THE PURPLE RIBBON: For readers who have commented or emailed objections to my use of the pancreatic cancer purple ribbon, I ask you to consider this advice Albus Dumbledore gives to Harry Potter in Harry Potter and the Philosopher's Stone, with which I heartily agree and applies to symbols as well as words:

"Call him Voldemort, Harry. Always use the proper name for things. Fear of a name increases fear of the thing itself."


Crabby Old Lady's Silly Complaints

This post is so silly that Crabby Old Lady almost left today's page blank. Her excuse is that it is all she had time for (it's amazing how busy doctors keep you when you have a serious disease) and she implores you not to laugh or make fun when you realize how ephemeral these are.

Two of her complaints involve fashion – one she is sorry to have missed and a second that is fairly serious if you like to dress nicely or, maybe Crabby is alone on this one.

Sparkly Makeup
These days, Crabby indulges only in a little blusher and light lipstick now and then but otherwise goes about her business with a naked face. That wasn't always so.

For most of her adult life, Crabby wore a lot of makeup although few noticed. She had the advantage of many years working with top makeup artists to the stars in television and they taught her a lot of tricks involved with enhancing one's better facial qualities and diminishing others without making the cosmetics obvious.

Crabby always liked playing around with makeup but when she retired and was getting older, it seemed excessive. And then, THEN, she discovered one day in a drug store sparkly blusher, sparkly eye shadow, even sparkly foundation.

Wow. What a great idea. It could be subtle for daytime or blatant for night. But it looked – and still looks – fantastic, but on young women, not old ones like Crabby although she might have some fun with it next Halloween.

This is a rare instance of Crabby Old Lady lamenting that she got too old too soon.

Sleeveless Clothing
What is it with sleeveless clothing? For the past few years, this has been driving Crabby nuts. She sees a shirt or blouse she likes, it works for her, the color is nice and then, second look – NO SLEEVES.

If you're shopping for clothes online, you can scroll for pages and pages without seeing sleeves. Even in winter clothes. Worse are those skimpy sleeves that stop just below the elbow – they look sloppy, unfinished.

Crabby suspects that it is just another way – in addition to overseas manufacturing and flimsy fabric (unless you can afford designer clothes) to make a greater profit. Imagine the amount of fabric no sleeves saves.

Crabby wonders if the clothing manufacturers know how much less clothing Crabby buys these days for lack of sleeves. And can she be alone?

Whatever Happened to Saying “You're Welcome”?
Since when, Crabby wants to know, is the response to “thank you” not “you're welcome”?

It is most obvious on the cable news programs when a host thanks a guest for taking time to be there and the guest says, “Thank you,” instead of “You're welcome.”

It has happened to Crabby Old Lady in “real life” too, although not as universally as on television. For example, on leaving a restaurant, she might thank a maitre d' for a nice meal and he/she almost always says “Thank you for coming.”

Can't anyone take a compliment anymore or just acknowledge a thank you with “you're welcome”?

Crabby is the first person to admit that these three old-lady complaints, especially given the problems in the world, are lighter than helium. But if Crabby has learned nothing else in her life, it is that she is never, ever the only person thinking whatever is on her mind.

So maybe you have some silly complaints too. Let us know below. And please forgive Crabby for this – she just ran out of time and brain power for anything more ambitious.


Ageism in Healthcare

Impactofageism

This story had been on my “to do soon” list just before my cancer diagnosis and now that my recovery is going so well, it's time to start catching up. Let me start with a couple of ageist profiling stories from Dr. Val Jones at the BetterHealth website:

”Take for example, the elderly woman who was leading an active life in retirement. She was the chairman of the board at a prestigious company, was an avid Pilates participant, and the caregiver for her disabled son.

“A new physician at her practice recommended a higher dose of diuretic (which she dutifully accepted), and several days later she became delirious from dehydration. She was admitted to the local hospital where it was presumed, due to her age, that she had advanced dementia. Hospice care was recommended at discharge. All she needed was IV fluids.

“I recently cared for an attorney in her 70’s who had a slow growing brain tumor that was causing speech difficulties. She too, was written off as having dementia until an MRI was performed to explore the reason for new left-eye blindness.

“The tumor was successfully removed, but she was denied brain rehabilitation services because of her 'history of dementia.'

“Of course, I recently wrote about my 80-year-old patient, Jack, who was presumed to be an alcoholic when he showed up to his local hospital with a stroke.”

These are not uncommon stories. One of the most serious side effects of ageism is inadequate health care. Another example from an important overview of ageism in healthcare was published in Generations, the journal of the American Society on Aging, in October 2015:

”The geriatrician and writer Dr. Louise Aronson (2015) describes a disturbing example of explicit ageism in which a surgeon asks the medical student observing his case what specialty she is thinking of pursuing.

“When she answers, 'Geriatrics,' the surgeon immediately begins mimicking an older adult complaining about constipation in a high-pitched whine. The attending surgeon had a reputation for being an outstanding teacher, yet repeats this parody throughout the surgical procedure.”

Let me pause here to say that the reason I was eager to get back to this topic is the excellent care I received at the Oregon Health & Science University (OHSU) hospital over nine days, which I wrote about here, that is in stark contrast to stories like those above which occur way too frequently.

Typesofageism

When health care providers harbor implicit or explicit prejudice against older patients, the possibility of under- or over-treatment increases – and that often starts with poor communication.

As the authors report in the Generations article, in one study doctors were rated as “less patient, less engaged and less egalitarian with their older patients.”

”One way healthcare providers unknowingly patronize older adults,” they continue, “is to use 'elderspeak' - speaking slowly, with exaggerated intonation, elevated pitch and volume, greater repetitions, and simpler vocabulary and grammatical structure.

“Older adults perceive elderspeak as demeaning and studies show it can result in lower self-esteem, withdrawal from social interactions, and depression, which only reinforce dependency and increase social isolation (Williams, Kemper, and Hummert, 2005).”

The authors also note that it is not just the providers who “may harbor or exhibit ageist attitudes. Older adults themselves often possess very negative views of aging, not realizing the potential impact on their health.”

This may be changing, however, among baby boomers who are more likely to be comfortable questioning authority than many of their older counterparts.

Older-adults-wordle

Ageism in healthcare is, of course, only one area of prejudice against elders but as the stories above demonstrate, it can be deadly. If you encounter any healthcare professional who is behaving in a demeaning manner or dismissing your complaints, politely explain that you expect and deserve his/her full attention and care.

Or, you could just fire the doctor and find a new one as I did last October when my then-primary care physician dismissed my symptoms that eventually led to the pancreatic cancer diagnosis as nothing but a mild virus an antibiotic would take care of.

Whenever I have written about ageism lo these many years, inevitably there is a pushback in the comments. Invariably one or more will quote the “stick and stones...” adage, insisting that derogatory names can't hurt them. Others deny that ageism is on a par with sexism, racism, etc.

Really? It's not okay to denigrate, stereotype and discriminate against women and people of color but okay for old people? Really?

No, not really. Let me tell you why ageism – in all its manifestations – matters to me. It is about justice, justice for everyone including old people. And because if I don't keep insisting, it will change me in ways I won't like.

International-day-of-older-adults-2016



ELDER MUSIC: Even More Hooked on Classics

Tibbles1SM100x130This Sunday Elder Music column was launched in December of 2008. By May of the following year, one commenter, Peter Tibbles, had added so much knowledge and value to my poor attempts at musical presentations that I asked him to take over the column. He's been here each week ever since delighting us with his astonishing grasp of just about everything musical, his humor and sense of fun. You can read Peter's bio here and find links to all his columns here.

* * *

This is really classical music, nothing to do with the dreadful series of records that came out many years ago with that name. The name of the original column was suggested by Norma, the Assistant Musicologist. Over time when I hear something I like, I save it. When I have enough for a column, it magically appears (if only). Let the magic begin.

RALPH VAUGHAN-WILLIAMS was offered a knighthood several times during his life and he refused each time. I applaud him and that alone is enough to get him into one of my columns. However, this is a music column so that will do for my commentary.

Ralph Vaughan-Williams

Ralph wrote some beautiful music - The Lark Ascending and Fantasia on a Theme by Thomas Tallis immediately come to mind. I'm not using either of those. Instead, here is something out of left field.

The tuba isn't used very often as a featured instrument. Before I found this I wouldn't have been able to name one instance. However, thanks to Ralph, we have a Tuba Concerto in F Minor, the second movement.

♫ Vaughan-Williams - Tuba Concerto (2)


Given his ubiquity these days, it might seem surprising that from soon after his death until the twentieth century, ANTONIO VIVALDI was completely unknown.

Vivaldi

Even now new works of his are being discovered in attics and toolsheds (okay, perhaps not those places, but they are being found). One composition that was known and performed in his lifetime is "Juditha Triumphans", an oratorio celebrating the victory of Venice against the Turks, and the recapture of the island of Corfu.

From that we have Juditha’s aria Transit aetas, performed by JOHANNETTE ZOMER.

Johannette Zomer

There's some mandolin work going on as well.

♫ Vivaldi - ‘Juditha Triumphans’ RV 644 Juditha’s arias ~ ‘Transit aetas’ for soprano mandolin & strings


I've never been a big fan of FRANZ LISZT, he's a bit too much of a show-off for my taste. Obviously, many others think differently as he's very popular, but that's alright.

Liszt

He was the rock star of his day and could show any of the modern musicians a thing or two in that regard. As you all no doubt know, his main instrument was the piano for which he wrote many compositions.

One of his compositions I like a bit is La Campanella in G Sharp Minor, although even this one has a bit too much extreme right hand work for my taste. This is from a series of six études for the piano based on compositions by Paganini. The pianist is Lang Lang.

♫ Liszt - La campanella in G Sharp Minor


GEORG PHILIPP TELEMANN was the most prolific composer in history – he wrote more compositions than anyone, thousands, and they were all at least good, and many magnificent.

Telemann

In spite of all that, he only wrote one viola concerto. Indeed, he is the first to have written one of those. His good friend Johann Sebastian Bach obviously listened closely to this as he wrote some violin concertos that sound almost identical, well, to the fourth movement anyway.

That's what we are going to listen to, the fourth movement of Georg's Concerto for Viola, Strings and Continuo TWV 51-G9 in G.

♫ Telemann - Concerto for viola strings and continuo TWV 51-G9 in G (4)


CAMILLE SAINT-SAËNS showed early promise, not just as a musician, but in all academic studies - Greek and Latin, literature, mathematics, astronomy and so on. He retained an interest in all these throughout his life.

Saint-Saëns

His musical instruction was at the Paris Conservatoire where he found fellow (later) composers César Franck, Georges Bizet and Adolphe Adam. Camille later taught as well, and one of his pupils, Gabriel Fauré, became a life-long friend.

Camille's best known works are his Organ Symphony and the musical suite Carnival of the Animals. Those don't float my boat.

What does, though, is the Romance for Horn & Piano, Op.67, here performed by two of the finest musicians from the last 50 years - BARRY TUCKWELL on French horn and VLADIMIR ASHKENAZY playing piano.

Barry Tuckwell & Vladimir Ashkenazy

♫ Saint-Saëns - Romance for Horn & Piano Op.67


JOHANN FRIEDRICH FASCH was born in a small town just outside Weimar in 1688.

Friedrich Fasch

Later he travelled throughout what is now Germany and held a number of musical positions in various towns and cities. He was once offered the job of Kapellmeister and court composer in Prague but he turned it down. That went to the second-best applicant, J.S. Bach.

He wrote many cantatas, symphonies, concertos and chamber music but none of his music was published in his lifetime. It's all been discovered since. Not all; it's thought that quite a lot has been lost.

Something that hasn't is the Concerto for Bassoon, Two Oboes, Strings and Basso Continuo in C minor, FWV L c2. This is the first movement.

♫ Fasch - Concerto for bassoon, 2 oboes strings and basso continuo in C minor (1)


It's not surprising that today's musical offering from BEETHOVEN features the piano. After all, he was the greatest composer for that instrument who ever strode the planet.

Beethoven

However, it isn't one of his famous sonatas or concertos. It's a piano trio, so there's a clarinet and cello along for the ride. It was written early on when he was still living in Bonn, where he was born, before he moved to Vienna to become the most famous composer in history.

Here is the third movement of the Piano Trio in B-flat major, Op. 11.

♫ Beethoven - Piano Trio in B-flat major Op. 11 (3)


CÉSAR FRANCK, or to give him his full first name, César-Auguste-Jean-Guillaume-Hubert Franck, was born in what's now Belgium but was then part of the Netherlands. However, he spent most of his life zipping around France.

Cesar Franck

Besides being a composer, he was considered to be a master of the organ and piano. As well, he had a reputation as a great improviser on both instruments. A century later he could have played jazz. He eventually settled down and became a professor at the Paris Conservatoire.

His compositions were the usual symphonies, chamber music and piano pieces. Besides those, he wrote the communion anthem Panis Angelicus. We have the sublime CECILIA BARTOLI singing that with harp, cello and organ playing along.

Cecilia Bartoli

♫ Franck - Panis angelicus


These days, GIOACHINO ROSSINI is best known, maybe only known, for his operas. Perhaps even just for the overtures to those - think "The Thieving Magpie", "The Barber of Seville", "William Tell" (the A.M. insisted I mention the Lone Ranger at this point, but I'm above that sort of thing).

Rossini

However, he wrote other works, some of which I'm amazed are not more well known or popular. One (or some, he wrote six of these) is what he called a string sonata. This is really a string quartet under a different name, with a double bass substituting for the viola.

He wrote all six of these when he was just 12 years old and before he had started formally studying music. What were you doing when you were 12?

The photo above was taken when he was a little older than that. The third movement of String Sonata No.3 in C Major.

♫ Rossini - String Sonata No.3 (3)



Cutting Cancer Down to Size

At a Wednesday follow-up appointment, my surgeon lifted most of my diet restrictions, “as long as you don't go hog wild,” he said.

If I took that as a sign that this pancreatic cancer won't always be at the forefront of my mind – and I did - a phone conversation later the same day not only confirmed that idea but gave me the determination to make it so.

My friend, Joyce Wadler, had called to check on how I'm doing (fine, thank you). She is a long-term survivor of two separate breast cancers and of ovarian cancer and her advice before my surgery was crucial to making my recovery easier and smoother than it otherwise would have been.

Joyce is the person who told me to make a list of everything I do every day, note which ones would become difficult or impossible after surgery and figure out what I would do about them.

I would never have thought to do that on my own and I silently thanked her every day when I got home. The only important thing I missed was the cat food and water bowls which, as I showed you here, a clever neighbor figured out for me.

Joyce's first bout with cancer took place in about 1990, the others following some years later. On Wednesday when we spoke, I was curious to know, especially after three times, how much cancer still plays a part in her life.

I asked because, as you can undoubtedly tell from the number of blog posts I've written about it over the past two months, my cancer is the central circumstance of my life nowadays. But even with a long road of chemotherapy and god knows what else ahead of me, I'm already tiring of this concentrated, all-day focus every day.

I'm tired of reminding myself to take certain medications before, during or after meals. I'm tired of the work involved in keeping prescriptions up to date. I'm tired of forcing food when I'm not hungry because it is important to gain back the lost weight.

I'm also tired of arranging my schedule for at least one appointment – and sometimes more - with a doctor each week. And all that in addition to physical therapy exercises twice a day, a tai chi routine once a day and at least one half-hour walk per day.

Whew. They do keep you busy, these medical folks. But I am starting to become resentful that it takes so much time that used to be my own to do with as I pleased - and chemotherapy has yet to be plugged into the schedule.

So it was heartening that Joyce's answer to my question about how much her cancers play a part in her life today is “not much.” That's what I want too and I want it sooner rather than later.

Joyce's “not much” has spurred me on to work out how I can cut cancer down to size so it's not my entire life.

In my case, for as long as I live there will be cancer doctors - for chemo, for regularly-scheduled scans to check on the cancer's development up or down, for other checkups. But in between I would like to just live in every other way that doesn't involve personal cancer awareness.

Maybe I can think of the medical appointments as visits with old friends. I like the physicians and their nurses and other assistants a lot and I already look forward to seeing them – just the not the topic of conversation.

Or maybe I can fit those visits in like I schedule a hair cut – a chance for some interesting conversation with a friendly professional I trust that doesn't impinge on my life in between.

And, too, further recovery should improve my appetite and I'll gain more expertise in tracking those pesky medications, so all that should help loosen cancer's hold on my mind.

I clearly recall, with Joyce's first cancer diagnosis so many years ago, that she either started or increased her sessions at the gym. She had to be strong, she said then, to get through the coming treatment. She worked hard at it and my memory of her determination then along with her advice on prepping my home for post-surgery and now her “not much” are my inspiration to keep cancer from defining me.

Joyce has written two books about her cancer, My Breast and Cured, My Ovarian Cancer Story (Plucky Cancer Girl Strikes Back) which are available at the usual book sources around the web.

You can also read Joyce's newspaper column, “I Was Misinformed”, which appears regularly in The New York Times. Hint: Like me, she often writes about the joys - and not - of growing old but she is much funnier than I am.


What Others Say About Death

Virgildeathquote

Compared to how I felt in the first couple of weeks following surgery (which was awful), I am more than pleased with how my recovery is going. However, about once a week, I have a bad night without a wink of sleep.

That happened to me Monday and today (Tuesday as I write this for Wednesday), I'm left with a brain too low-functioning to tackle anything that requires much thought or organization. So I'll let others do the speaking.

A cancer diagnosis certainly does focus the mind on the far end of life and I have been checking out what some people – ancient and modern, well-known and not – have had to say about it. Here are a few I have enjoyed pondering:

“We cannot banish dangers, but we can banish fears. We must not demean life by standing in awe of death.” – David Sarnoff
”Death is more universal than life; everyone dies but not everyone lives.” - Andrew Sachs
“Don’t cry because it’s over. Smile because it happened.” – Theodore Geisel (Dr Seuss)
“A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist.” – Stewart Alsop
”No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life.

"It is Life's change agent. It clears out the old to make way for the new.” - Steve Jobs (who died of pancreatic cancer in 2011, eight years after diagnosis)
”To fear death, my friends, is only to think ourselves wise, without being wise: for it is to think that we know what we do not know. For anything that men can tell, death may be the greatest good that can happen to them: but they fear it as if they knew quite well that it was the greatest of evils. And what is this but that shameful ignorance of thinking that we know what we do not know?” - Socrates
”Life does not cease to be funny when people die any more than it ceases to be serious when people laugh.” - George Bernard Shaw
“Now he has departed from this strange world a little ahead of me. That signifies nothing. For us believing physicists the distinction between past, present, and future is only a stubbornly persistent illusion.” – Albert Einstein
“I’ll bet in Heaven they have one single word that means ‘back when I was alive’. You know, to save time in meetings and stuff.” – Derek Littlefield

What about you? Do any of these speak to you? Do you have any you want to share with us?


Living on the Edge of Life

Pancreaticcancerawareness160leftTomorrow will mark six weeks since my surgery for pancreatic cancer and I think I am doing remarkably well. The long incision down the middle of my torso is healed. Hardly any pain related to the surgery remains.

Although I am still unwilling to lift anything heavier than six or seven pounds, I am doing everything else for myself now, if a little slowly, and I drove for the first time over the weekend. It went well.

The overwhelming fatigue has lifted but by late afternnoon, I'm done for anything more than lying around, and that gives me plenty of time to ponder my predicament: the malignant tumor was successfully removed from my pancreas but there are those three pesky lymph nodes (and more that were not tested?) where the pathologist found cancer cells.

In about ten days I will spend time with the medical oncologist to find out all about what chemotherapy can do about that. Having that treatment is, of course, my choice but recovering now from surgery that was the hardest thing I've ever done, I doubt I'll reject giving chemo a chance to work.

Meanwhile, I am living in a sort of twilight zone of an unknown precarious future. Sometimes I try to imagine what the cancer looks like and picture it gone, poof. Other times I think of it as an enemy, as I would any person who is trying to kill me, that I must fight with all my might.

Neither of those work for me, especially the second. I can't seem to rustle up a mental scenario of bodily war against cancer. Lack of imagination, I suppose.

Many people have told me I'm brave and courageous but I don't know about that either. Bravery, to me, means lack of fear in face of danger and that's certainly not true of me right now. I am definitely afraid of the future.

Having courage, on the other hand, is to take on a dangerous adversary while also feeling overwhelming fear.

You may think that, particularly in agreeing to chemotherapy to fight the cancer, I am being courageous and for me, chemo is as frightening as cancer itself.

But I see it differently: that I must live in the world as it is and what it is now - a cancer that can kill me - doesn't change whether I am afraid or not so courage doesn't enter into it.

The possibilities for my future are simple and obvious:

The chemotherapy works and with or without additional treatments, the cancer goes into remission and am granted some reasonable number of additional years

The chemotherapy doesn't work and I die sooner rather than later

It's such a mystery, death is. Our culture sees it as the ultimate adversary to be fought against relentlessly. My current fear notwithstanding, I believe death is the natural order of things – nothing else makes sense to me.

Further, I've always thought that as the time of my death approaches, I would gradually lose interest in the world around me – I watched that happen to my great aunt and several friends who died decades younger than she did. But the thing is, faced with this medical catastrophe, I haven't lost interest.

Well, maybe I have to a degree. As I have recovered from the surgery, I have lost interest in most non-news television, even many of my favorite shows. Suits, for example, seems much less compelling this season, less well written, more soap opera. Is it them or is it me? I can't tell.

And it's not just recovery that has slowed me down. I take time outs during the day to try to think about how I want to spend the time I have left, and about dying - what I need or want to do to be ready for it.

I don't get much further than the idea I hold that death is a normal, peaceful process and that I would like to be awake as I die – to experience it.

Mostly, however, I have not come to terms with dying yet, which leaves me living on the edge of life. It is impossible to imagine that the world will go on without me to keep an eye on it. Silly, of course, that. And so many other unresolved issues to work on. But just for today, I have places to go and things to do, fully engaged as though this hasn't happened to me.

"Life is pleasant. Death is peaceful. It's the transition that's troublesome." - Isaac Asimov