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 39 Night - Liver Biopsy Past and a Certain Circumstance of Taking Joy in Another's Success

My liver biopsy took place two days ago, and it wasn't the end of the world or even close. It was strange and uncomfortable and painful in places your mind tells you that you should not be experiencing pain, but it is past. I could go into the semi-gory details, but what's the point? The most uncanny moment is when you hear the metallic click inside your body of the metal clipper needle snapping off a miniscule piece of your liver. The fact that they have to do it twice is a bit unnerving. I closed my eyes so I would not see what was happening because I was awake with only a local anesthetic.

You realize as it is happening that your body truly is a sacred vessel that should not be invaded by anything foreign. When I consider all of the foreign crap I have put into my body over the years, I shake my head, take a deep breath and let the regrets pass over me and vanish into the framework of the night. I am powerless over regrets because I cannot change the past so what is the point of having them. I laugh when I think of the old nineties T-shirt — "My body is a sacred temple sinking slowly into ruins." It's funny because every image that I find on Google images of the body as a sacred temple, using various word combinations, is goofy and unsatisfactory. It's all either New Age crap or Science Fiction mumbo-jumbo or just plain silliness. Nothing that reflects the deep spirituality and the connection within and without as our physical form expresses the journey of the soul. This is as close as I got to even liking an image, and it still echoes of universal grandiosity of man as the center of everything.

I like this image and dislike it at the same moment in time...

This is how I described my liver biopsy on Facebook... John Lavitt really does not recommend to any of his friends or even enemies (not really enemies, just the disgruntled avoiding bunch) getting a liver biopsy. You are fully awake, and it feels like getting kicked by a horse inside of your body. It freezes that moment when after the first pain of the kick when your breath vanished and you wheeze with the recognition that the next wave of deep dull, almost uncanny, ache cannot be stopped.

And now for something completely different (a reference by the way to a somewhat forgotten Monty Python film). When you are walking a spiritual path, you often don't see the changes that have happened in your being and your way of interacting with the world. I have noticed consistently that other people are aware of the changes before you even recognize them. When they tell you how you have evolved, you can understand what they are saying and realize that it's true and intellectually agree with them, but you do not feel the change on a primal level. It does not flow through your veins and swirl in your soul. What is amazing is when you have a moment when the change hits you on a visceral level and you are truly able to experience your own growth and spiritual evolution. A prime example...

Reza Safai in the Independent Film, Circumstance 

It's funny because I meant to write about this last week, but like so many things, it got caught in the crossfire and slipped away from me. Last Saturday, I saw the opening of my friend Reza Safai's film Circumstance at the ArcLight Hollywood. Reza is the male star of the film, and Circumstance was written and directed by the brilliant Maryam Keshavarz.  It centers on a wealthy Iranian family that struggles to contain a teenager’s growing sexual rebellion and her brother’s dangerous obsession as it navigates the dangerous waters between forbidden love and extreme religious orthodoxy. The film was beautiful and precise and an inspiration to watch. Written in Farsi, the director and all the leads come from Iranian families that go back and forth to Iran. They all have extended family still in the country. 


What is so powerful is that they had to make such an extreme choice in order to make the film. By making a film that is critical of the morals and politics of the current regime, the artists knowingly made the choice to never return to their homeland. Although most were born in the states, they are Iranian, and they identify with the history and traditions of Persian culture and society. Think about it! We often discuss what an artist sacrifices in order to create their art? Could you make such an extreme sacrifice? Could you choose to separate yourself from your land because of the necessity of expressing what you believe in your heart and your soul? Tough questions, and brave answers by these artists. No wonder the film won the Audience Award at the Sundance Film Festival in 2011.

But I am not writing a movie review. What I loved about the experience is how I was able to take such joy in the success of my friend without feeling even the slightest tinge of envy or jealousy. I truly have come to believe that the success of others never diminishes me in any way, and if everyone realized their dreams of success and creative vision, the world would be a much better place. I no longer feel the need, except when I relapse here and there on my character defects, to compare myself to other people. Being able to relish and savor the success of Reza, knowing how hard he worked and how much he believed in the film, came so naturally that it did not even occur to me until I was driving home that I had felt nothing negative the entire night. I mean, Reza worked for two years with a dialect coach to perfect the specific Farsi accent spoken in a certain upper class neighborhood. The fact that his work paid off in such amazing ways and led to his part in a beautiful film is how the world should work. 

There is such freedom in the process of letting go of the basic seven deadly sins. They are sins not necessarily because they are evil, but because they weigh us down with the burden of fear and prevent us from walking in the comfort of faith. When I can find joy in the successes of my fellow human beings without feeling envious or jealous, I am able to experience the world as it should be — present, loving, and supportive.

Day 37 Morning - Liver Biopsy Fears and My Song To Sing

Although it is day 37 according to the clock, it is not quite morning. 4:30 AM is one of those in-between times where the previous and the coming day mesh together in the silence of sleeping souls and wandering minds. At 9:00 AM in the coming morning, I am going to have a liver biopsy at Olympia Medical Center, a procedure that has been described to me as a swift horse kick in your side. Although I am not quivering and my hands are steady, there is a certain fear lurking in the back of my mind. Such a medical procedure just simply sounds unnatural and not what is supposed to be happening to a human being as the sun rises on a Thursday morning. Alas, what is supposed to be happening and what will happen are two vastly different continents that are separated by the ocean of my reality.

Although I can dream of a far-off fantasy world and life where every wish comes true and the twilight lasts all day long, it remains only a dream. Tomorrow morning I will have to wake (that is, of course, if I actually sleep again) and face the simple reality of my friend picking me up at 7:40 AM to take me to the eventual destination. Such an eventuality will not pass and will not vanish into the framework of the night. Still, in the stillness, how I love the quietude and peace of this time. And there is no wrong in such dreams, no fault to be criticized or even contemplated for long, as long as the dream does not get in the way and undermine the right path of the eventual moment that lies before me.

Last night, I went over to the newly bought home of my friend Randy and his wife Christine to have dinner and spend some time with them. Being huge supporters and, if I may be so bold, even lovers of my poetry, I brought a whole series of past work to read to them. It was a delightful reading with a smile dancing across Randy's countenance as he experienced the words. Afterwards, he said that the smile was born of being transported into the emotional reality and evolutionary process of the work as though it was his own experience.

Randy had heard many of my poems before, but this was Christine's first reading. And her sweet and loving reaction simply took my breath away. As I read of love lost and the challenge of being human amid the chaos of this life, she closed her eyes and began to tremble, then gave way to the emotion within her as she opened them and the tears came. It always is such an astonishing moment when you see how your work has the power to deeply affect another human being. At the end of the reading which comprised over 25 pages of poetry, Christine announced that she had decided to start writing and find out what was in her own being to express. Nothing means more than the God-given ability to inspire another person to delve into their own depths and find their own song. And once again (how many times has it happened and how many times have I abandoned the lesson?), I remembered the simple truth of my own purpose on this planet earth.

Like all of us, I was given the gift of a song to sing. In the Dialogue of the Savior, a fragmentary but legitimate (in my opinion, the only external Gospel that accesses the actual teachings of Jesus besides The Sayings Gospel of Thomas) Gnostic text that reveals Jesus talking with his disciples, this lesson is made clear. In my own compilation Gospel (it's a whole nother story that we'll eventually get into) that incorporates both The Sayings Gospel of Thomas and The Dialogue of the Savior into a narrative compilation of the traditional four, I end a sequence where Jesus teaches the disciples in private after gathering them together with the following:

Simon Peter, who would be called the rock, asked Jesus, "Then tell us, Master, 

what is the beginning of the way?"

   Jesus smiled and said, "Love and goodness, Simon.  The beginning of the way 

is always love and goodness. 

Allow what is within you to sing, and those will be the songs of your Father." 

Mind you, I am not a Christian or a believer in Christ in the Pauline sense or in the evangelical tradition that was started with John the Evangelist. Rather, I am a huge fan of Jesus the teacher, and the fancy miracles, the transcendental issues, and the resurrection do not matter to me. What matters to me is the miracle of the teachings and the parables. The Sermon on the Mount, The Parables of the Prodigal Son and the Good Samaritan, the saving of the adulteress from stoning in Jerusalem and the washing of the disciples feet are more than enough for me to love and respect and learn from the teacher. Anyone else's beliefs are really none of my business, and whatever works for you and gets you through the night is fine  with me as long as you display the love and care and respect that the great spiritual teachers showed to others as well.

Jesus Giving His Blessing - Hans Memling (1478)

Okay, forgive the explanatory interlude, but I felt it was necessary. There is another blog and another time and another place for the details of my own faith. What is more essential right now is that the poetry reading tonight reminded me deep within of the song that I was put here on this earth to sing by my father in heaven. When I write "my father in heaven", I choose not to capitalize because essentially it is a metaphor and one that I feel works for me and is comfortable. Basically, when it comes down to the brass tacks, I really am just a well-developed and evolved monkey with a computer, and the forces behind the universe remain an incredible mystery to me. I choose, however, to believe that this universe is civilized with some kind of divine intelligence or energy operating behind the scenes. As a result, I choose once again to avoid the closed fists and stomping feet of the exclamation points (!) and embrace the wondrous mystery of the question mark (?).

I have been writing for sixty straight minutes and I am starting to fade a bit. After all, I do have quite a morning rapidly approaching. But I will end with this conviction: I know I have a song to sing, and I will use the crucible of my Hepatitis C treatment to bring forth my song and focus on what really matters for me in the blink of an eye that is this rare human birth. As Jesus expressed so clearly in line from The Sayings Gospel of Thomas that inspired my entire attempt to compile my own version:

   "Truly I promise, the kingdom of God is within you. 

   "If you bring forth what is within you, 

what you bring forth will save you.  

If you do not bring forth what is within you, 

what you do not bring forth will destroy you."

If I had one wish at this very moment, it would be that we all experience the sweet grace and the divine opportunity of bringing forth the beauty and the wonder that is within our souls.

Day 25 Night - The Weight of Being A Burden on My Family

Over the past couple of days, I have been feeling the weight of being a burden on my family as I prepare to go through treatment. My business is not going terribly well, and I am not sure if I will be able to keep up with it when treatment begins. According to all my sources, the first two months of Interferon treatment tend to be pretty terrible, wiping out the patient every week with flu-like symptoms. Since I will be officially admitted to the clinical trials next week and I will have a liver biopsy, each day is becoming more important to prepare for the coming treatment. But I simply do not have the resources right now to do everything I want to do to make sure that it will be a smooth and sane process. I know I will get through this next hurdle, but it creates a lot of stress and anxiety. My psychiatrist has told me that it is essential for me to reduce stress at this point in time, fostering an internal equilibrium that will carry me through the process. I know in my heart that everything will be okay, but I honestly am frightened right now.

Emotional Baggage and the Overwhelming Weight of the Past

I have put my family through more shit than any family deserves or should ever have to deal with in several lifetimes. The guilt over the damage caused during my years as a drug addict and the weight of those regrets is sometimes downright overwhelming. I try my best to stay positive and believe that everything is going to ultimately work out, but often I sag beneath the burden I chose and created. I mean, I cannot avoid the weight of my own responsibility, and I have to accept the reality that this is what I did to myself and nobody else is to blame. I wish acceptance meant change, but I so often relapse on my character defects and act like an addict or alcoholic, slipping down the slope of indulgence and self-pity and self-centered bullshit. Honestly, I so want to realize the dreams of my life and walk the walk on the path that my God has laid out before me. If I am to succeed on that level and walk through this crisis with grace and dignity, I must toss aside the easy bullshit of the couchaholic. I have to have faith that everything is going to work out and that my health will be restored and I will have another chance to be and to become the man I was put here on this earth to be.

I can do this and I will get through this crucible with the love and support of my family and friends. Please forgive me if I wallow in such small emotions here and there. If I do not drain my head of this crap, it becomes a toilet swirling with the refuse of my disease. Even worse than a toilet, it becomes a dangerous neighborhood with my fears transformed into criminals looking to mug and rob my dreams, my hopes, and my soul. I know that's a bit much, but it is strangely true. Even now, I feel the pollution of this disease in my body, and I know my liver is not working properly to clean out the bile. But the disease barely has a foothold and if I can survive treatment and move forward, I believe it will be eradicated from my body and I will be given a new lease on life. Let's hope and pray...