Day 87 Night - A Strange, Challenging Array Of Questions And Accusations Lurking In My Head

Very little has changed, but certain decisions need to be made. If I am to move forward successfully with this treatment, there are questions that need to be asked and inner accusations that need to be resolved. Although many will be raised in this entry, I doubt that many will be answered. The first step is opening the door and being willing to step inside. The picture a bit melodramatic, but it hits the nail directly on the head with a certain vengeance.

What Is Behind Your Door? What Is Lurking?

As Halloween approaches, it is a dark house with very little to be seen beyond the accusatory shadows and the questionable silhouettes. I have spent close to half a lifetime trying to escape reality and pretend that my delusions were on the verge of coming true. But this treatment has excised the dancing bears and the pink elephants, leaving me alone with an itchy rash on my body and very little of value to hold onto in the midst of this storm. It is not a fear of panic; it is just the understanding that there is no turning back and there is no turning my back on the questions and accusations lurking within.

How Do I Differentiate Between The Question Marks And The Crucible?

A Start to Questions & Accusations; Observations on those Dreams

1) If the side effects do not improve and I continue to feel my sanity being ravaged by the itching, will I be able to successfully continue this treatment until the end? I have never been much when it comes to completion in my life; it is a negative quality that verges on human heresy by turning my back on the gift of taking the action to express my authenticity. When I was 12 years old and spendng the summer at Camp Cobbossee, our bunk counselor was a Tennessee Vol baseball player named Doug Lawry. At the end of the summer, he gave each of us a picture of himself hitting a home run with an inscription on the back. My inscription quoted my favorite lines that I had read in an Archie comic book that summer: A Winner Never Quits, A Quitter Never Wins. Whether from Vince Lombardi or Archie, it remains a pertinent cliche for me today.

Can I Stop Quitting, Surrender My Bullshit, And Join The Winning Side?

2) Since I always embraced the dream that I would be loved in my life and that I would meet the woman who would be my true partner in this life, will this vision come true or am I just fooling myself? Right now, as I sit in the Bourgeois Pig in Hollywood, I am surrounded by beautiful young women, and I am old enough to a father to well over half of them. Still, as I sink into the morass of a dirty middle-aged man, I am still attracted to young women and I still harbor the fantasy. Can I afford to do this anymore? Right now, I feel so unattractive, despite the fact that the rash is covered up by my smothering long-sleeve shirt and these scratchy blue jeans. Although I dream of having the passion and conviction of Pepe Le Pew without the vast delusion, I wonder what I still have to offer. Although there is a certain freedom in my failure, there are unblinking consequences as well. Even when I decide to date a woman my own age or close to my own age, what do I really have to offer? Will I be loved again?

Can my passion be ignited again beyond the silly danger of delusion?

3) If I truly have accepted the failure of my life and abandoned those Hollywood dreams, can I move forward without the weight of regret and discover the freedom offered by such a surrender?  Boy, this is a hard question to answer and an even harder reality to face. The only reason I have been able to do it is because I have been stripped down to the bare bones by this treatment and these side effects. It doesn't seem like my bullshit works anymore, and how I miss my casual belief in those sparkling delusions. Still in the popular culture and particularly about a dozen years ago, the definition of excellence realized was the basketball prowess of Michael Jordan. Considered the greatest basketball player of all time, Michael Jordan expressed how intimately connected his success was connected to his failures. By failing over and over again but continuing to believe in himself and work hard with a sense of determination, he created his phenomenal success. Mind you, I understand that Michael Jordan is a flawed human being with failings on and off the court, but isn't that the very point to be embraced. If I accept my failures while maintaining my faith in myself, everything will be okay. Not necessarily wonderful, but a-okay with moments of beauty and creation in between the itches.  

The Bridge Between Failure and Success is Determination and Belief

More to come tomorrow, but that is all for tonight. My arms and legs are itching like crazy and my concentration flags because I cannot seem to push it beneath the surface of this consciousness.

Day 86 Night - There Is The Perfect Exhaustion Of Knowing That This Is Going To Continue Tomorrow And There Is No Relief Today

I am so worn out tonight. When I bump into friends and acquaintances, I put on a brave face and say that is everything is going to be okay and I am not lying when it comes to the future. The lie only infects the present when I am not okay, and there is nothing anyone can do. If nobody can help you and you are forced to simply survive, what is the sense in sharing the burden and asking for help?

A Perfect Exhaustion

But my back hurts tonight for real because I tweaked it while sleeping twisted up on the couch. I am sorry because I do not want this to be about my complaints but tonight I am so tired and sleep seems so very far away. I have to get up early in the morning to see a new and improved dermatologist about the rash that is spreading, and I am worried if I take a sleeping pill, I won't wake up in time.

Such is the price of living alone. The comforts of isolation that verge on the pathetic at times are no consolation. I need more than these words and more than your love. I need the promise of health returning home to roost. If I am to build a nest that I can believe in, then I need to embrace the faith that this hell is working.

It is. My numbers are normalizing as my liver functions improves. But the virus still lurks and is far from defeated. I do not know if it will ever be excised from my body. I do not know if I am doing the right thing by going through this experimental treatment. I do not know if I am a wise man or  a fool. And the fear of foolishness creeps up and mugs my soul in the belly of the night.

R-Evolution-Blues by Rene Sinkjær (Triptych in process) 

I am not quite as colorful as the painting, but I am as much of a chaotic mess. It is weird to experience exhaustion and chaos side-by-side. It is like quicksand and not struggling even though you continue to sink. But I am not sinking into death or unconsciousness. And struggling will only make me sink faster. Tonight feels like a drowning of my soul.

Day 85 Night - How Many People Are Infected With The Hepatitis C Virus In The United States (3.5 to 6 Million), Worldwide (160 Million Minimum), And What Is The Ultimate Cost?

I don't know whether these statistics can be believed. Are 2.7 million people chronically infected with the hepatitis C virus in the United States, or could that number be as a high as 6 million? Since the vast majority of infected people are unaware that they have been infected and have no symptoms for as long as 10 to 15 years, it is extremely difficult to gauge the true numbers. The only way to find out is to have a blood test specifically for the virus.

In 2002, I was in a serious car accident, in an induced coma for two weeks, and in the hospital for 2 1/2 months, yet none of the tests done uncovered the virus. At the same time, I am positive that I was infected in 1999 when I shared a needle. Unless you give blood or have your blood specifically screened for such viral infections, you will not know whether you are infected or not. And how many of you ever give blood? When was the last time you gave blood at a blood drive? Can you imagine how many people became infected through blood transfusions, tattoo needles, intravenous drug use, and the like before there were proper screening and safety procedures?

Addressing a growing epidemic

The HCV Infected (the best statistics available): 

Over 160 Million Worldwide  

2.7 to 6 Million United States

Country Estimated 2004 total Estimated HCV Population studied

population (millions)      seroprevalence (%)

China 1300 3·2 Nationally representative sample (n=68 000)

India 1087 0·9 Community-based, West Bengal (n=3579)

USA 294 1·8 Nationally representative sample (n=21 214)

Indonesia 219 2·1 Volunteer blood donors (n=7572)

Brazil 179 1·1 Volunteer blood donors (n=66 414)

Pakistan 159 4·0 Volunteer blood donors (n=103 858)

The word "hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver. The most common types are hepatitis A, hepatitis B, and hepatitis C. Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). HCV infection is the most common chronic bloodborne infection in the United States; approximately 4-6 million persons are chronically infected. San Francisco has the highest liver cancer rate in the nation, most of which is attributed to high rates of hepatitis B and hepatitis C virus infections.

Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available.

Sixty to 70% of persons newly infected with HCV typically are usually asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1–3 weeks after exposure. The average time from exposure to antibody to HCV (anti-HCV) seroconversion is 8–9 weeks, and anti-HCV can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70%–85% of HCV-infected persons; 60%–70% of chronically infected persons have evidence of active liver disease. The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection.

HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through transfusion of blood from unscreened donors or through use of injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV.

The role of sexual activity in the transmission of HCV has been controversial. Case-control studies have reported an association between acquiring HCV infection and exposure to a sex contact with HCV infection or exposure to multiple sex partners. Surveillance data also indicate that 15%–20% of persons reported with acute HCV infection have a history of sexual exposure in the absence of other risk factors. Case reports of acute HCV infection among HIV-positive MSM who deny injecting-drug use have indicated that this occurrence is frequently associated with other STDs (e.g., syphilis). In contrast, a low prevalence (1.5% on average) of HCV infection has been demonstrated in studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection. Multiple published studies have demonstrated that the prevalence of HCV infection among MSM who have not reported a history of injecting-drug use is no higher than that of heterosexuals. Because sexual transmission of other bloodborne viruses, such as HIV, is more efficient among homosexual men than in heterosexual men and women, the reason that HCV infection rates are not substantially higher among MSM is unclear. Overall, these findings indicate that sexual transmission of HCV is possible but inefficient.

What is the incidence of HCV infection in the United States?

Although only 849 cases of confirmed acute Hepatitis C were reported in the United States in 2007, CDC estimates that approximately 17,000 new HCV infections occurred that year, after adjusting for asymptomatic infection and underreporting. Persons newly infected with HCV are usually asymptomatic, so acute Hepatitis C is rarely identified or reported.

What is the prevalence of chronic HCV infection in the United States?

Approximately 3.2 million persons in the United States have chronic HCV infection. Infection is most prevalent among those born during 1945–1965, the majority of whom were likely infected during the 1970s and 1980s when rates were highest.

Who is at risk for HCV infection?

The following persons are at known to be at increased risk for HCV infection:

• Current or former injection drug users, including those who injected only once many years ago
• Recipients of clotting factor concentrates made before 1987, when more advanced methods for manufacturing those products were developed
• Recipients of blood transfusions or solid organ transplants before July 1992, when better testing of blood donors became available
• Chronic hemodialysis patients
• Persons with known exposures to HCV, such as
  • health care workers after needlesticks involving HCV-positive blood
  • recipients of blood or organs from a donor who tested HCV-positive
• Persons with HIV infection
• Children born to HCV-positive mothers 

Is it possible for someone to become infected with HCV and then spontaneously clear the infection?

Yes. Approximately 15%–25% of persons clear the virus from their bodies without treatment and do not develop chronic infection; the reasons for this are not well known.

How likely is HCV infection to become chronic?

HCV infection becomes chronic in approximately 75%–85% of cases.

Why do most persons remain chronically infected with HCV?

A person infected with HCV mounts an immune response to the virus, but replication of the virus during infection can result in changes that evade the immune response. This may explain how the virus establishes and maintains chronic infection.

What are the chances of someone developing chronic HCV infection, chronic liver disease, cirrhosis, or liver cancer or dying as a result of Hepatitis C?

Of every 100 persons infected with HCV, approximately

• 75–85 will go on to develop chronic infection
• 60–70 will go on to develop chronic liver disease
• 5–20 will go on to develop cirrhosis over a period of 20–30 years
• 1–5 will die from the consequences of chronic infection (liver cancer or cirrhosis) 

Can persons become infected with a different strain of HCV after they have cleared the initial infection?

Yes. Prior infection with HCV does not protect against later infection with the same or different genotypes of the virus. This is because persons infected with HCV typically have an ineffective immune response due to changes in the virus during infection. For the same reason, no effective pre- or postexposure prophylaxis (i.e., immune globulin) is available.

Is Hepatitis C a common cause for liver transplantation?

Yes. Chronic HCV infection is the leading indication for liver transplants in the United States.

How many deaths can be attributed to chronic HCV infection?

Chronic HCV infection accounts for an estimated 8,000–10,000 deaths each year in the United States.

Is there a Hepatitis C vaccine?

No vaccine for Hepatitis C is available. Research into the development of a vaccine is under way.

Transmission and Symptoms

How is HCV transmitted?

HCV is transmitted primarily through large or repeated percutaneous (i.e., passage through the skin) exposures to infectious blood, such as

• Injection drug use (currently the most common means of HCV transmission in the United States)
• Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
• Needlestick injuries in health care settings
• Birth to an HCV-infected mother

HCV can also be spread infrequently through

• Sex with an HCV-infected person (an inefficient means of transmission)
• Sharing personal items contaminated with infectious blood, such as razors or toothbrushes (also inefficient vectors of transmission)
• Other health care procedures that involve invasive procedures, such as injections (usually recognized in the context of outbreaks)

What is the prevalence of HCV infection among injection drug users (IDUs)?

The most recent surveys of active IDUs indicate that approximately one third of young (aged 18–30 years) IDUs are HCV-infected. Older and former IDUs typically have a much higher prevalence (approximately 70%–90%) of HCV infection, reflecting the increased risk of continued injection drug use. The high HCV prevalence among former IDUs is largely attributable to needle sharing during the 1970s and 1980s, before the risks of bloodborne viruses were widely known and before educational initiatives were implemented.

Is cocaine use associated with HCV transmission?

There are very limited epidemiologic data to suggest an additional risk from non-injection (snorted or smoked) cocaine use, but this risk is difficult to differentiate from associated injection drug use and sex with HCV-infected partners.

What is the risk of acquiring HCV infection from transfused blood or blood products in the United States?

Now that more advanced screening tests for HCV are used in blood banks, the risk is considered to be less than 1 chance per 2 million units transfused. Before 1992, when blood screening for HCV became available, blood transfusion was a leading means of HCV transmission.

Can HCV be spread during medical or dental procedures?

As long as Standard Precautions and other infection control practices are used consistently, medical and dental procedures performed in the United States generally do not pose a risk for the spread of HCV. However, HCV has been spread in health care settings when injection equipment, such as syringes, was shared between patients or when injectable medications or intravenous solutions were mishandled and became contaminated with blood. Health care personnel should understand and adhere to Standard Precautions, which includes safe injection practices and other guidance aimed at reducing bloodborne pathogen risks for patients and health care personnel. If health care-associated HCV infection is suspected, this should be reported to state and local public health authorities.

Can HCV be spread within a household?

Yes, but this does not occur very often. If HCV is spread within a household, it is most likely a result of direct, through-the-skin exposure to the blood of an infected household member.

What are the signs and symptoms of acute HCV infection?

Persons with newly acquired HCV infection usually are asymptomatic or have mild symptoms that are unlikely to prompt a visit to a health care professional. When symptoms occur, they can include

• Fever
• Fatigue
• Dark urine
• Clay-colored stool
• Abdominal pain
• Loss of appetite
• Nausea
• Vomiting
• Joint pain
• Jaundice

What percentage of persons infected with HCV develop symptoms of acute illness?

Approximately 20%–30% of those newly infected with HCV experience fatigue, abdominal pain, poor appetite, or jaundice.

How soon after exposure to HCV do symptoms appear?

In those persons who do develop symptoms, the average time period from exposure to symptom onset is 4–12 weeks (range: 2–24 weeks).

What are the signs and symptoms of chronic HCV infection?

Most persons with chronic HCV infection are asymptomatic. However, many have chronic liver disease, which can range from mild to severe, including cirrhosis and liver cancer. Chronic liver disease in HCV-infected persons is usually insidious, progressing slowly without any signs or symptoms for several decades. In fact, HCV infection is often not recognized until asymptomatic persons are identified as HCV-positive when screened for blood donation or when elevated alanine aminotransferase (ALT, a liver enzyme) levels are detected during routine examinations.

Testing and Diagnosis

Who should be tested for HCV infection?

HCV testing is recommended for anyone at increased risk for HCV infection, including:

• Persons who have ever injected illegal drugs, including those who injected only once many years ago
• Recipients of clotting factor concentrates made before 1987
• Recipients of blood transfusions or solid organ transplants before July 1992
• Patients who have ever received long-term hemodialysis treatment
• Persons with known exposures to HCV, such as
  • health care workers after needlesticks involving HCV-positive blood
  • recipients of blood or organs from a donor who later tested HCV-positive
• All persons with HIV infection
• Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
• Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months)

What blood tests are used to detect HCV infection?

Several blood tests are performed to test for HCV infection, including:

• Screening tests for antibody to HCV (anti-HCV)
  • enzyme immunoassay (EIA)
  • enhanced chemiluminescence immunoassay (CIA)
• Recombinant immunoblot assay (RIBA)
• Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR])
• Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)

Background: Defining the primary characteristics of persons infected with hepatitis C virus (HCV) enables physicians to more easily identify persons who are most likely to benefit from testing for the disease.

Objective: To describe the HCV-infected population in the United States.

Design: Nationally representative household survey.

Setting: U.S. civilian, noninstitutionalized population.

Participants: 15 079 participants in the National Health and Nutrition Examination Survey between 1999 and 2002.

Measurements: All participants provided medical histories, and those who were 20 to 59 years of age provided histories of drug use and sexual practices. Participants were tested for antibodies to HCV (anti-HCV) and HCV RNA, and their serum alanine aminotransferase (ALT) levels were measured.

Results: The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV–positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV–positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA–positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA–positive participants between 20 and 59 years of age.

Limitations: Incarcerated and homeless persons were not included in the survey.

Conclusions: Many Americans are infected with HCV. Most were born between 1945 and 1964 and can be identified with current screening criteria. History of injection drug use is the strongest risk factor for infection.

Day 85 Night - Let's Get A Little Medical Because That Whimpering Son Of A Bitch Is Trying Not To Complain Or Even Itch Tonight

Here is the Surgical Pathology Report about my Liver Biopsy (9-1-2011) from the Department of Pathology and Laboratory Medicine at Olympia Medical Center. I added all the parts in italics that help to describe terms and words that were difficult to me to understand. This is how we began...

FINAL DIAGNOSIS:

LIVER (NEEDLE CORE BIOPSY)
- Chronic Hepatitis with mild activity (Grade 2 of 4)
- Portal fibrosis (Stage 1 of 4)

(What is Liver Fibrosis: 

Fibrosis is excessive accumulation of scar tissue that results from ongoing inflammation and liver cell death that occurs in most types of chronic liver diseases. Nodules, abnormal spherical areas of cells, form as dying liver cells are replaced by regenerating cells. This regeneration of cells causes the liver to become hard. Fibrosis refers to the accumulation of tough, fibrous scar tissue in the liver.)

MICROSCOPIC EXAM:
Microscopic sections of the needle core biopsy demonstrate two cores of liver parenchyma (the functional part of the organ) with an overall intact architecture. There are approximately thirteen portal tracts (Portal tracts: These are islands of connective tissue containing branches of the portal vein and hepatic artery, running side by side, that bring blood to the sinusoids. They also contain bile ducts, which carry bile in the opposite direction to the blood flow.) present for review. The portal vasculature and bile ducts appear unremarkable. Most of the portal tracts are expanded by a lymphocytic infiltration with ocasional spillover. In addition, scattered lymphocytes are found in the lobules. Few apoptotic hepatocytes are noted. (Hepatocytes: These are parenchymal cells that form plates. They are the main functional cells of the liver. Apoptotic Hepatocytes indicate acute liver damage.) There is minimal macrovesicular steatosis estimated at less than 1%. (Macrovesicular steatosis is the most common form and is typically associated with alcohol, diabetes, obesity and corticosteroids.) 

The trichome stain highlights mild fibrous expansion of the portal areas. There is no bridging fibrosis. The PAS stain with and without diastase highlights the above finding. No alpha-1 globules are seen on the PAS with diastase stain. The iron stain shows no increase in iron deposits. The reticulin stain highlights 1-2 cell thick plates.

GROSS DESCRIPTION:
The specimen is received in formalin in a container labeled with the patient's name (that's me!), medical ID number and designated as "liver biopsy." It consists of two cylindrical tan-brown-white tissue fragments <0.1 cm in diameter x2.0 cm and 2.3 cm in length. The entire specimen is submitted in a biopsy bag.

Not A Lot Of Fun: Liver Biopsy Image Courtesy of the Mayo Clinic

For those of you with scientific minds and medical degrees...

Nomenclature, grading, staging of liver biopsies

A recommendation to replace the old terminology for chronic active and chronic persistent hepatitis (Popper, 1971; Rev International Group, 1968) is now becoming widely accepted for a variety of reasons (Gerber, 1992; Ludwig, 1993; Scheuer, 1986). The new nomenclature would use "chronic hepatitis" with the addition of a grading of activity of the hepatitis based on the degree of inflammation and necrosis and the stage of fibrosis. The terminology will also include the etiologic agent or cause, if known (International Working Party, 1994).

Several grading and staging systems have been proposed that use a variety of scores (Bedossa, et al, 1994; Desmet, 1994; Ishak, et al, 1995; Ludwig, 1993; Scheuer, 1991). Many of these systems have been modified from Knodell, 1981. Examples of a simple and a somewhat more complex system are given.

System adapted from Ludwig, 1993

Portal and Lobular Inflammatory Activity

0       None or minimal portal inflammation, no necrosis
1       Portal inflammation chronic persistent hepatitis without necrosis and/or lobular inflammation without     evidence of necrosis.
2       Mild limiting plate necrosis (mild chronic active hepatitis) and/or focal lobular necrosis.
3       Moderate limiting plate necrosis and/or severe    focal cell damage
4       Severe limiting plate necrosis and/or bridging    necrosis.

Fibrosis

Stg 1   No fibrosis or confined to enlarged portal zones
Stg 2   Periportal or portal-portal septa but intact     architecture
Stg 3   Septal- fibrosis with architectural distortion;    no obvious cirrhosis

Stg 4 Probable or definite cirrhosis
System adapted from Ishak, et al, 1995
Necroinflammatory Scores

        Score                    Pathology
A.    Periportal or periseptal interface hepatitis

         (piecemeal necrosis)

        0               Absent
        1               Mild (focal, few portal areas)
        2               Mild/moderate (focal, most portal areas)
        3               Moderate around less than 50% of tracts or septa)
        4               Severe continuous around more    than 50% of tracts or septa

B. Confluent necrosis

        0               Absent
        1               Focal  confluent  necrosis
        2               Zone 3 necrosis in some areas
        3               Zone 3 necrosis in most areas
        4               Zone 3 necrosis, plus occasional
                        portal-central (P-C) bridging
        5               Zone 3 necrosis, plus multiple    P-C bridging
        6               Panacinar or multiacinar necrosis

C. Focal (spotty) lytic necrosis, apoptosis and focal inflammation

        0               Absent
        1               One focus or less per 1Ox         objective (ob)
        2               Two to four foci per 10x ob
        3               Five to ten foci per 10x ob
        4               More than ten foci per 10x ob

D. Portal inflammation

        0              None
        1              Mild, some or all portal areas
        2              Moderate, some or all portal areas
        3              Moderate/marked, all portal areas
        4              Marked, all  portal  areas

Architectural Changes, Fibrosis/Cirrhosis

        0               No fibrosis
        1               Fibrous expansion of some portal areas, with or without short fibrous septa
        2               Fibrous expansion of most portal areas, with or without short fibrous septa
        3               Fibrous expansion of most portal areas with occasional portal to portal (P-P) bridging
        4               Fibrous expansion of portal areas with marked bridging (P-P as well as P-C)
        5               Marked bridging (P-P and/or P-C) with occasional nodules (incomplete cirrhosis)
        6               Cirrhosis, probable or definite

And that's how the liver bounces...

Day 83 Night - The Four Crack Quartets: Remembering What I Did To Myself And Why I Must Walk With Dignity Today

I understand how tough these last few entries have been and how they hurt the ones I love because they worry about me and they feel helpless. I am sorry to be the source of more suffering. You must understand that I am doing this for a reason. I am not a poor soul who lost the genetic cancer lottery and was told by a doctor that there is a malignant tumor in my liver. I did this to myself, and I must take responsibility.

There will be no pictures in this blog except the one picture of me taken a few years ago in Mexico. The casual leaning on the tongue lashing my ass kind of fits the bill. It shows the remnants of the poser and the ultimately cool Hollywood guy that will always be lurking somewhere in me.

John Lavitt Posing with Graffiti in Ensenada, Mexico in 2007

Below are four poems I wrote in 1994 when I gave in to cheap desire and became a crack addict. As you know from past entries, it was one of the ugliest times in my life. And it truly frightens me when I realize that it took close to another decade for me to hit bottom and finally get sober. All that time with brief stopping points and geographical escapes, I was an unforgivable addict. First crack, then cocaine and heroin. Always smoking except the one time that I shared a needle and was infected with the Hepatitis C virus. It sound like extraordinary bad luck, but it seems appropriate to me that such actions result in such consequences.

I have placed the four poems under a single heading in somewhat twisted homage to T. S. Eliot and his celebration of wastelands and alienated losers. After all, the names of Eliot's first two quartets are Burnt Norton and East Coker. It seemed to make sense in a strange sort of way since the themes of the first two poems of the series are described by C. K. Stead as...


1. The movement of time, in which brief moments of eternity are caught.
2. Worldly experience, leading on to dissatisfaction.
3. Purgation in the world, divesting the soul of the love of created things.

Such themes when mutilated surely reflect the horror as expressed below...

           

the four crack quartets

how accurate

long walk in darkness and silence,

a deafening cry pounding inside,

flooding the chambers, cheap desire,

so much freedom given away so soon,

mutilated on her altar, unrecognized,

rotting, and i almost gave my life

away, almost sacrificed my life

for smoke, my life for smoke.

can barely remember how it began;

when bitterness rose like vapor,

expanding into a cynical answer.

how quickly it filled my life,

how little there was to fill.

i'm not scared of these sentences.

today is not trembling with fear.

is tomorrow a burnt offering?

we expose horror in routine.

through routine the smoke

rises, habits rising night to night

until vergil and the dark descent

is no longer a poet's metaphor.

i pass him by, taking no notice,

noticing now only and forever

how cold and damp my palms,

how accurate the shaking.

more

this is amazing!

i am killing myself

with each rising breath

of bitterness, sweet

bitter smoke rising.

it has stolen me flat.

it creeps and lies readily

and more often in night

amid the slow emptiness,

slowly demanding more

the dive into a wave of death,

youth cruising on the crest

of a wave breaking, breaking

into my soul and the good life

sinks, drowning in ashes

dark magic, deluded, blinded,

the journey down and deeper

into buried lies, obscured

by the smoke and she calls

and i come and i abandon

all whys to the wanting,

i fall, solitary liar falling,

without fighting, bereft

of doubt, ignoring all fear:

this is just a passing fancy,

a consumer on the edge

of hell, american hell perfect

where the soul shrivels black,

the crack they sell extracts

wanting, wanting always more.

away

i have seen what the smoke

can destroy, almost without warning;

how readily i ignore the danger,

tossing the worst outcome aside

even when the worst is sure to arrive.

the real cost multiplied: pound of lung

and the disfigurement of pride.

ask and you shall see what lies:

all the smart reasons why i won't die,

why i'll never sink with the suicides;

because this, this is a crazy adventure,

a youthful romp down the road to hell

where hope withers, love impaled

on the wanting, cheap and ready.

the smoke; ready with the answer

to a question asked so carelessly.

my god, i gave your gifts away,

sacrificed more than good, more than evil,

more than the first taste from the tree –

hell - i murdered the first possibility.

all my potential reduced to residue,

ambition drowning in wet hollow sighs

as the fire god ignites an empty life

and i forget why i needed to escape,

forget the notion of escape, my life

so readily replaced by smoke slipping

into glassy eyes, engulfing all dignity

as the dream shrivels and friends die.

really o.k.

even rain falling

falls into the delusion

of rock, thin wet flakes

lurking under my tongue

in reflections of tin foil

i watch the very best lies

gently rise into smoke,

rising past all potential.

cold fingers rattle now,

waiting forever for one more

taste of sweet heaven-scent,

sinking swiftly into more

waiting, struggle to remain

a little more high and i

will be fine, i'm really o.k.

if there's one more hit,

but stillness never comes,

only the desperate maintenance

of purgatory, soon exhausted,

shivering into morning light.