Day 57, Monday, March 25th, 2013

Note: As I write this, I have a morphine drip on the go that I am in charge of and an icepack crammed between my butt cheeks. We'll get to why.

I've casually mentioned mucositis a number of times in previous posts, but I'd like to get a teense more specific on the subject, as it has had direct ramifications on the last week of my life, and will likely continue to do so for the next week or two.

Mucositis is (and I'll just quote from Wikipedia here) "...the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy for cancer." As we've discussed, I have received a rather potent chemotherapy agent (cyclophosphamide, a goddamn nitrogen mustard) and I've also had a non-trivial amount of radiation applied to my entire body. These seemingly extreme measures were employed for a very specific reason: the achievement of the myeloablative effect - the negating of the ability of the bone marrow to produce cells. The effects of mucositis usually take a day or two to manifest, and increase in severity, generally peaking around days +7 to +9 from transplant, which is day 0.

I've actually had uncommonly little in the way of mucositis up to and including this point: It's only just now, on day +6, that I'm even starting to lose my hair again (pubes first again, what is with that?). I've had a teeny bit of inflammation in my mouth and a raw spot in my throat, and I spent most of yesterday sleeping off a fever (also totally normal and expected). Frankly, from a statistical perspective, I am kicking ass.

Important bit: your "digestive tract" includes the continuous set of organs from lips to anus. Food goes through it? It's part of the tract. Unless, of course, you've just swallowed something into your lungs, in which case you now have other priorities than the strict definition of your tract (fun fact: digestive system includes all of the other contiguous organs that secrete, process, and filter)

That bit about the anus is where all of this becomes directly relevant.

Oh, sweet boopin' Jesus, my butthole hurts.

I haven't been this scared to poop since I was four and saw the cover of a horror movie that had a monster coming out of the toilet; scarred me for years.

[a quick googling reveals that it was most likely Ghoulies, I would have been five, and that five year old me was an enormous wuss].

It began thusly; sometimes, post-defecating, one must wipe repeatedly, endlessly, in order to achieve a pristine puckered pooper; after radiotherapy, this became the norm. This, of course, led to rawness, which I did bring to the attention of my medical team, though perhaps a day or two later than I honestly should have. We tend to be shy about our most prominent of sphincters. Well, lesson learned. My team prescribed some Boston Butt Cream, which is its actual pharmaceutical name. It's on the printed label from the pharmacy. Boston Butt Cream has lidocaine and a little hydrocortisone in it, and it both soothes and numbs. I didn't find it entirely sufficient for my needs and asked if there were a more potent a step up, perhaps an Alabama Ass Cream? It turned out that there was not an Alabama Ass Cream, and I was quite thoroughly disappointed by this. At any rate, the Boston Butt Cream^TM helped for a day or so. Then I had my bottom inspected by a nice young man who was ...you know, I never did ask if he was a doctor. He did have a lab coat on, at least. He declared me fissure and hemorrhoid free, which was nice, and arranged for two different kinds of medicated wipes for the tender region, as well as another type of cream that isn't nearly as much fun to say.

This resulted in a drastically reduced desire to defecate, and also a lot of Oxycodone, which, as a narcotic, also contributed to the accumulation of feces. Narcotics tend to constipate you, and so they did. This, in turn necessitated stool softeners, which means you pop the pills, drink a river, walk around a lot and pray to Ja Almighty that the turtlehead breaks up enough to make dropping a deuce a thing that can happen. I hadn't felt that backed up since I went on a week-long portage trip when I was thirteen and refused to poop in the woods. I did not make good decisions as a thirteen-year-old.

That course of action lead, eventually, to significant success, with the exception of the fact that it still really, really hurts to "go number two."

This is why I have that splendid pump, which allows me to dole out morphine at the touch of a button, though not quite at the rate that I would like. It makes me wait six minutes between presses of the button, and one is not enough, so I have to premeditate by at least twelve minutes. I have it that I may prepare myself for the ordeal, and it is also why I have an ice pack like lodged like a frosty wedgie between my splendid buttocks.

It will all pass, I just wish it do it a little less excrutiatingly.

Peter: "Excuse me, do you have any books on toilet training?"

Salesman: "Oh, of course! 'Everybody Poops' is still the standard; there's also the less popular 'Nobody Poops But You'."

Peter: "Hunh, see, well, we're Catholic, so..."

Salesman: "Oh! Then you'll want 'You're a Naughty Child and That's Concentrated Evil Coming Out the Back of You'."

Peter: "Perfect!"