Medical Emergency Relief

** HISTORY **:
67-year-old male patient with history of gastric cancer presenting
for restaging evaluation.
** FINDINGS **:
Comparison: 06/22/2015
Technique: Axial images of the chest, abdomen, and pelvis were
obtained with administration of Omnipaque 150 cc intravenous.
CTDI: 6.8 mGy
DLP: 444.9 mGy-cm

CHEST:
There is patchy airspace opacity within the basal segments of the
left lower lobe, new when compared to study date 06/22/15. The
right lung is clear without focal consolidations, pleural
effusions, or pneumothorax. There are no suspicious pulmonary
nodules/masses identified.
There is no cardiomegaly or pericardial effusion. Coronary artery
calcifications are present. There is a left-sided 3-vessel aortic
arch. The thoracic aorta is normal in caliber without evidence of
aneurysmal dilatation or focal dissection. There are no filling
defects within the central pulmonary arteries.
There are no pathologically enlarged axillary, supraclavicular, or
mediastinal lymph nodes by CT criteria.
Mildly heterogeneous right thyroid lobe with a subcentimeter
hypoattenuating nodule.
ABDOMEN/PELVIS:
Circumferential wall thickening involving the gastric body/antrum,
compatible with clinical history of gastric cancer, mildly
improved when compared to study dated 06/22/15. No regional
lymphadenopathy or thickening/infiltration of the surrounding
omentum/gastric fat is appreciated. The downstream loops of small
and large bowel are normal in caliber without evidence of
obstruction or ileus. The appendix is not visualized. There is
moderate descending and sigmoid colon diverticulosis without
evidence of acute diverticulitis.
The liver parenchyma demonstrates normal attenuation without
intra-/extrahepatic biliary duct dilatation or focal lesions. The
hepatic and portal veins are patent. There is conventional
hepatic arterial anatomy. The gallbladder is unremarkable without
radiopaque stones.
There is no splenomegaly or focal splenic lesions identified. The
pancreas is normal without ductal dilatation or focal lesions.
The adrenal glands are symmetric bilaterally without nodularity or
hyperplasia.
The right kidney demonstrates normal enhancement without
hydronephrosis, focal mass lesions, or radiopaque stones. The
right ureter is normal course and caliber.
The left kidney demonstrates mildly diminished parenchymal
enhancement with moderate hydroureteronephrosis to the level of
the vesicoureteral junction. There is eccentric wall thickening
involving the left posterolateral urinary bladder wall, new when
compared to study dated 06/22/15. There are subcentimeter
low-attenuation foci within the left kidney which are too small to
definitively characterize, possibly representing renal cysts.
There is an enlarged prostate gland with mass effect on the post
urinary bladder wall, measuring 4.5 cm in maximal AP dimension.
The abdominal aorta is normal in caliber without aneurysmal
dilatation or focal dissection. The SMA, IMA, and celiac trunk
are patent. However, there is high grade stenosis/luminal
narrowing involving the proximal SMA (50-75%). There are single
renal arteries bilaterally. Extensive atherosclerotic plaque
throughout the abdominal aorta and bilateral iliac vessels. The
IVC is patent.
No suspicious osseous lesions are identified. There is multilevel
degenerative change of the thoracolumbar spine and right hip.
Partial visualization of an old fracture deformity involving the
left ischium.

** IMPRESSION **:
1. Circumferential wall thickening involving the gastric
body/antrum, compatible with clinical history of gastric cancer,
mildly improved when compared to study dated 06/22/15.
2. Eccentric thickening of the left posterolateral urinary bladder
wall with moderate upstream left hydroureteronephrosis and mildly
diminished left renal parenchymal enhancement, new when compared
to study dated 06/22/15. Findings may reflect a nonspecific
cystitis with an underlying mucosal mass lesion not excluded.
Recommend correlation with urine cytology/urinalysis and direct
visualization.
3. Patchy airspace opacities within the basal segments of the left
lower lobe, possibly representing areas of atelectasis with
developing infiltrates or radiation pneumonitis not excluded.
4. Superior mesenteric artery atherosclerotic plaque contributing
to high-grade stenosis/luminal narrowing (approximately 50-75%).
G GONZALEZ M.D.
DD: DT: 10/30/2015

Come Aug 12^th, I will feel like the last man out of a burning house.I am now approaching the end of all Modern Medicine can do for me.Only one recommendation did I decline, that of gastrectomy, or the total removal of my stomach.As I have reported previously, all delivered and proposed procedures were deemed palliative, not curative, a diagnosis repeated by my radiologist today.

I have outfitted my Van, Urge The Americruiser, and she sits much more patiently than I while waiting for departure.Every moment here is painful, physically, emotionally, and mentally. My need for release from months of hospitals, doctors, tests, procedures and fatigue, mental fog, neuropathy, mouth sores, et all, is making me Mad to hit the road.Folks like to think this kind of adventure is somehow romantic and ?Bucket List? cool.Don?t be fooled.People have always had a great affinity for community and permanence, a predictable routine and order.These are incompatible with a vagabond lifestyle and the Legend/Freedom Tour then is reaction to uncertainty and fear, a way to occupy body, mind and soul, filling my world full of new experiences and opportunities for wonder and thereby blunt the sharp edge of the impending.

"Doctor," said he, "as I believe you would not choose to tell anything but the truth, you had better tell him, that I am dying as fast as my enemies, if I have any, could wish, and as easily and cheerfully as my best friends could desire." ? David Hume

My Medical Emergency Fund expires August 11^th.I am currently struggling to extricate myself from some unanticipated expenses and financial obligations here that will end upon the start of my road trip.This is my final plea before my departure, please distribute through your social networks if you will as many of you might have contact with people I know but I may not be in touch with. Remember, we elected a President with lotsa $5 contributions! For all of you who have stepped up already, I can only say you have my deepest gratitude and sincerest thanks.

?He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has." - Epictetus

Thank you, and bless you!

So, as I spoke of in my last update plans changed due to extended care recommended by my Doctors. Well, sold the BMW and found my new Freedom/Legend Tour conveyance in a very nice, older but well maintained Ford Econoline 150 Camper/Van which has totally consumed me these last few days with getting set up for my journey. Unfortunately, as the accumulated effects of this new round of Chemo and Radiation wears on, my energy level and physical condition begins to seriously limit my activities.

However, the light is at the end of the tunnel should be full sunlight by mid-August. I will hit the road September 1. I Plan on travelling first up through California, Oregon and Idaho, re-visiting old friends and old haunts.From Boise I?ll be using a mix of Interstate and Blue Highways to wend my way east with possible stops in Michigan, Connecticut and New York before reaching the Clevenger ancestral home in the Shenandoah Valley of Ol? Virginny.Returning west late fall to rendezvous with some other like-minded RV?s and Flyers in Arizona to caravan to Mexico for?.awhile.

Now, all my travel plans are fluid. Weather, experiences and temptation may create a whole new map every day.Certain periodic and possible episodic medical factors might be a factor. Regardless, It?s the Nomad life for me until the Cancer outcome reveals itself one way or t?other?..

Support of the End-of-Life Option Act (SB 128)

End of first week of the second death march with health care.This round lasts for 6 weeks of treatments, weekly chemo, daily radiation.By the time I am capable of riding the weather will have turned. It has forced me to rethink my freedom/legend tour plans. I sold the bike and am now looking for a camper van??.

?Death leaves a heartache no one can heal, love leaves a memory no one can steal".- Irish headstone

Medical Emergency Fund update: Having made the decision to forgo Stomach removal, I will instead undergo radiation in 4 to 6 weeks. I plan on hitting the road the first of July and returning for that procedure and then heading out again.

I am very close to my goal, still paying off most of my medical bills and other financial impediments but am real close. Please, if you who have contributed, thank you and no need to do so again.I ask only that you forward to those mutual friends I may not have contact info for or who you think might be sympathetic.

My sincerest Thank You!

Nearly six months from diagnosis to a complete six cycle Chemotherapy regime I will be finished with the Chemo June 4^th.As you may be aware from my last update, I was advised to undergo a complete stomach removal. I have decided to not, as it really does not improve my prospects, estimated @ 7-10% for survival, significantly. I will continue to pursue my Cannibidol Therapy as it has aided me through depression, anxiety, nausea, neuropathy, and lethargy over the last six months.

So, the evolving plan is this: Lease on my apartment is up end of June. I am liquidating all I own and taking off via a BMW R1200GS motorcycle for a solo tour of the U.S. I plan on visiting friends and family scatted all over the county and camp along the way. Once on the road and free of rent, utilities, insurance, etc etc, I can manage on my SS.

I am very close to my goal, still paying off some medical bills and other financial impediments but am real close.For those of you who have contributed, thank you and no need to do so again.I ask only that you forward to those mutual friends I may not have contact info for or who you think might be sympathetic.

I am more than hopeful I?m gonna beat this, but I don?t intend to wait around to die.

My sincerest Thank You!