So Far, Nothing’s Been Bigger Than This (or The “C” Word) - 6/24/11
Sometimes life comes at you fast and furious. I feel like I’ve been waiting for the other shoe to drop but never wanting it to. My father used to tease me with such playful threats in allegorical form like, “mess with the bull, you’ll get the horn” or “heavy, heavy hangs over thy head” and one of my all time faves, “… better than getting poked in the eye with a sharp stick”.
From that, I gather that the “bull” is life, “the horn” is bad stuff we experience in life, “heavy” is the “shoe” which is also bad stuff we experience in life that hasn’t happened yet but could at any moment and the “sharp stick” is the shit that’s really bad that could’ve happened but didn’t, which is good I guess (i.e., things could be worse). It all sounds like farmer fill-osophy to me. But, it does make sense transcending that Scott, Ohio
Anyway, Lisa got a sketchy mammogram in May. Then she got a biopsy that was “NOT cancer” but possibly pre-cancerous, atypical ductal hyperplasia and atypical lymphoid population. Further testing at a lab in Bellingham
The scene became surreal and Lisa might as well have been across the Grand Canyon or the Pacific Ocean . Why wasn’t I sitting next right next to her? I moved a seat over to try and comfort her and when she got over the opening shock (a sky diving term), she immediately started asking what was next. She’s quite brave and strong under all those tears I thought. The awkwardness continued. (6/29/11 ) The general surgeon ran through the gamut of possibilities that these results partially indicated.
It was a lobular carcinoma that often has tendrils/fingerlings extruding from a not quite nodular but thick mass into surrounding tissue. It was an early stage form and one that is considered a “garden variety” cancer that is rather slow growing and not too aggressive. We were told that it probably has been in her right breast from four to six years and they were just now able to detect it. The treatment could be as simple as a lumpectomy and some radiation therapy. Or, if it has advanced to the lymph nodes, it could be growing elsewhere along the lymphoid chain. We could be talking more drastic measures.
The general surgeon asked Lisa if her curly hair was naturally curly and began explaining how chemotherapy will tend to straighten it or cause her to go bald in which case there were excellent sources of wigs or scarves available. It didn’t end there. She went on to discuss possible mastectomies, single or double as if ordering an espresso. It was all too mind numbing to take. I wanted to leave immediately and take my sweet, precious wife with me and get away from all of this seemingly hackneyed madness. When do we discuss leaches, bloodletting, arsenic treatment and/or amputations? Oh, we already discussed amputations (in the form of mastectomies).
Surely There Had Been Some Mistake - (7/1/11 )
When the general surgeon asked us if we had any questions, I asked if they were sure it was Lisa’s results we were talking about? She assured me that it was because their hospital was not a big huge city hospital the chances of mixing up records/results was extremely low. And, that’s why she encouraged us to let her do the surgery.
When the general surgeon asked us if we had any questions, I asked if they were sure it was Lisa’s results we were talking about? She assured me that it was because their hospital was not a big huge city hospital the chances of mixing up records/results was extremely low. And, that’s why she encouraged us to let her do the surgery.
The scheduling discussion began and we went along with it, agreeing that we’d stay local. We didn’t need to go to the big city and have all of our procedures done there. We’d be close to home. We’d keep it in the neighborhood where we could get the close nit support of our local hospital and staff. There’d be a few preliminary pre-surgery appointments. The very next day she would have blood drawn for DNA testing to test for faulty/mutated genes, BRCA1 and BRCA2, known to be a link to women who are predisposed to contracting breast cancer. We wouldn’t get the results back from the BRCA gene tests until the 22nd of June. So, the surgery would be scheduled for the 29th of June. This was all happening so fast.
But by the next day, we had time to let it sink in. I was wondering why we were thinking a general surgeon should perform the operation? How many had she done? What was her record? I called Lisa and told her we should discuss this with the experts in Seattle
From there it became a series of visits to Seattle Swedish Medical Center Toronto
We were told that the mass was small, slow growing and as far as they could tell, relatively localized. Lisa would get an MRI of her right breast and possibly her upper torso to help with the diagnosis that afternoon. The procedure entailed an injection of (?) which would indicate where the leaky cancer cells—they leak—were leaking and whether or not other areas were being affected. Unfortunately we wouldn’t know immediately since the data needed to be post processed.
After the appointment at Swedish, we had a meeting with an oncologist. We decided that we’d go with Dr. Beatty. He set up our pre-operative meetings and Lisa signed on for an experimental procedure that entailed getting injected with radioactive sugar fluoro-deoxyglucose or FDG and another type of mammogram called a Positron Emission Mammogram (PEM). We opted for this due to the explanation that it would “light up” the sugar sucking cancer cells. What was in doubt was how far the cancer had spread so this was an excellent way to see if it had gone any further than where the previous mammogram, ultrasound and MRI had shown. The experiment part was just to determine the dosage of the super short half-life FDG was needed for detection.
I started looking at this as a series of variables in one of the most important calculus equations in our lives. There were so many variables and we only had the values to a few of them. So we had the initial change detected by a mammogram. We had an ultrasound. Then we had a biopsy to determine the type and character of the cells in the mass. The results hinted at pre-cancerous stage. Then we had further lab examination to confirm the preliminary results. Here we went from not cancer to definitely cancer and cancer type. Then we had a blood test to determine genetic predisposition to contracting breast/ovarian cancer. This was followed by an MRI and an a tad later, an experimental PEM.
At this point, between the DNA test, MRI and the ensuing PEM test, we were crossing our fingers regarding the results. If Lisa’s genes were positive for mutated BRCA1/BRCA2 and/or the MRI/PEM showed more spreading/sites of cancer, we’d be talking mastectomy or mastectomies and chemo and radiation and reconstructive surgery and . . . It was daunting to say the least. We had scheduled appointments to see two reconstructive plastic surgeons the following week.
But, when we went to see our oncologist at Thomas Family Cancer Center
We had to return to Seattle
The sentinel node diagnosis couldn’t be determined until the day of the surgery and potentially a subsequent pathology examination. In the operation, the surgeon would locate the sentinel node and visually inspect it. He then will biopsy it and hand it over to an in situ pathologist for microscopic inspection. If it all looked good, the lumpectomy would continue simply as that. If not, the axillary lymph node cluster would be removed as well and tested further for signs of cancerous cells by pathologists at the lab.
Light It Up!
InSeattle
In
Dr. Rogers explained the procedure and the results with ample detail in layman’s terms. We were looking at a single mass of about 1.17 cm. He thanked Lisa for helping to determine appropriate dosages for future women facing similar circumstances. In fact, this procedure promises to provide early mammogram type detection for women who have larger and higher density massed breasts that make it difficult to impossible for regular mammography to see potential cancer masses.
Each test thus far, beyond the initial confirmation of cancer, was going as well as we could expect. We ended the day with another appointment with Dr. Beatty’s office/staff. This would be the pre-operative meeting to explain the surgical procedures and what the patient needed to do and not do and sign consent forms. The next time we come to Seattle
That day came fast. We had a turning 30 party for our niece Mary the weekend before. Our niece from Tacoma Seattle Crown Plaza
Lisa was very brave during all of the pre-surgery procedures, like getting a wire inserted around the mass, being injected with even more radioactive material, etc., etc. Mike and Nancy had gone to a Mariners’ game the night before and made it to Swedish to visit just before surgery. We were all able to see her and visit a bit but ultimately it came to her having to walk down one hallway while I was pointed toward the elevators.
I went to the Surgery Information booth and given instructions and a beeper. She would be operated on at , she’d be in recover around , or so I thought. She was out before . Dr. Beatty came by and gave me the lowdown. Everything went smoothly and the preliminary sentinel node exam looked good. We’d get the detailed pathology report by Friday, Tuesday at the latest.
Mike and Nancy were joined by their son Kyle and we all were able to go into recovery and visit. Lisa was groggy but coming around. She looked good but it’s always touch and go after surgery. I remember last year’s back surgery. Anytime pain medication is involved, she’s gonna blow, sooner or later. Mike and Nancy and Kyle said their goodbyes and Lisa was left to doze off for a few minutes here and there.
Before long, the nurse asked her if she needed to go potty and Lisa said she’d try. The nurse and I escorted Lisa across the ward but before too long, Lisa got queasy and the nurse grabbed a little tub. Sure enough, Lisa emptied her stomach. She recovered from that and was able to use the facilities. She went back to her recovery lounge chair/gurney. They don’t make them like they used to, this one looked like some sort of Lazy Boy manufactured recliner with props.
Nicole showed up from Tacoma Seattle Tacoma
Once we were all home, Lisa and I chilled on our couch in the basement and napped and watched TV. We were exhausted. Lisa went to bed early and I stayed up to watch a movie no one else wanted to, Battlefield L.A. The next day Lisa and I woke up and she had had quite a restful sleep all things considered. Today, we puttered around the house, explored the back yard, made breakfast after and ultimately just hung out on the back patio. The sun finally broke through and Shirley, Lisa’s mom, planned a BBQ rib dinner complete with corn on the cob and steamed leeks (I think).
We weren’t really expecting a call from Dr. Beatty’s office today, but when the telephone rang, we made sure it was near us so we could answer it if it was. Somewhere around , the phone rang and it was Dr. Beatty’s office. Lisa took the call and walked away from the music we typically play on the patio so she could hear better. The report was back. The lymph node pathology was clear, negative! We’re scheduled to meet with Dr. Beatty and a slew of ologists next Thursday at to discuss treatment from here. I high fived Lisa!
The only other result in the wings was an oncogene (dX) test. Our oncologist recommended it to determine the likelihood of recurrence and best course of action for treatment. Based on this particular test, the oncologist and doctors will best be able to determine which drugs and treatment will need to be considered. If the test comes back with a relatively low percentage chance of recurrence, radiation and tamoxifen may be all that’s needed. Here's to hoping for the best.
When Life Gives You Hills . . . SHIFT, STOMP & GRIND! - (7/11/11)
We just got back from the Group Health sponsored, Cascade Bicycle Club run Seattle to Portland (STP) Bike Ride. It has become an annual event for Lisa and I since 2005. The ride itself has been held since 1979 (the year I graduated from high school) with the exception of 1980 when Mt. St. Helens blew. After much distress and forethought, Lisa decided not to ride the STP this year. Her lymph node incision has given her some pain and the thought of riding 204 miles in two days with any other pain than the usual nails in the butt, knees of rusting bolts and broken glass, feet on fire, torture rack back, general numbness in any or all of the five points of contact on a bike would not be welcome/warranted/etc. I believe it was the best decision. The jarring of the roadway with fresh surgical incisions did not sound . . . sound to me.
We headed to Seattle on Thursday to meet with Dr. Beatty to discuss the post operation details. Funny how it is, that the one thing you overlook or forget about always comes back to bite you in the ass! This very thing happened upon meeting with Dr. Beatty Thursday afternoon. When they take out a cancerous mass from the breast, they take more than just the area they can see/detect. I believe they use a radioactive die to "light up" the tumor and take a certain percentage or "margin" of tissue around said mass. I (we) kinda forgot about the fact that they examine this margin area microscopically to determine proximal limits. That is, how far are there "cancer free" cells from the cancerous ones in the tissue that they surgically extracted.
That is what the meeting with Dr. Beatty on Thursday afternoon in Seattle was all about. The pathological report on the margin tissue came back. Lisa was free and clear by 10mm on all axis of the tissue except the lateral area. This was only 1mm clear of cancer. Remember when your little sibling didn't want any of their food on their dinner plate to touch? Even if it was just the juice from the green beans or the gravy or the meat, it became detestable to them? Well, this was like that only on a mortal scale. Translation: Lisa will have to go under the knife one more time to remove more tissue in the lateral region and have it tested to confirm she is indeed free and clear of any malingering cancer cells beyond the prior 1mm margin. Hey, if you're clearing a minefield, you wanna be doubly sure it is indeed clear of mines!
Oh, and did I mention that they found the cancerous mass to be twice the size that they could detect with all of those detection methods I mentioned earlier? Yeah, well, yeah, almost exactly that is what happened. They found the mass to be 2.5cm! That means the "early on set Stage One" gets reclassified to "Stage Two". Which, by the way, means that we now have to seriously consider chemo-therapy. I can't put into words how this made us feel. Dr. Beatty made sure to schedule the rescission/surgery so that once the oncogene dx test comes back, we'd have all the data we needed to determine whether or not to proceed with putting a surgical port into Lisa so that the chemotherapy could more readily and conveniently be administered. The surgery is scheduled for the 20th of July. We've a meeting with Lisa's oncologist on the 18th.
I rode the STP while Lisa rode with Reenie down to Centralia on the first day and then to Portland on the second day. It was perfect weather, cool in the morning and warming much later in the afternoon. The skies were clear the first day and partially cloudy the second but by the afternoon, the sun came out in force. The first day, I met a guy who struck up a conversation with me just past the University Bridge. He rode strong and fast and I tagged along as best I could but by the first incline of any significance, his higher thrust to weight ratio dropped me. Funny thing though, I ended up bumping into him several times after each time I got dropped due to the hills.
His name was/is Jason. We chatted about how often we'd ridden the STP and, of course, I had to mention that my wife usually accompanies me on these and that this was the first year she would not be and why. As it turns out, his wife had undergone a similar scenario via lumpectomy, etc. and that she ultimately had to opt for a double mastectomy. Perhaps he was drawn to the giant pink ribbon I brandished on my George Hincapie jersey we bought to signify our struggle. He is from Vashon Island and ride the flats at a blistering 22mph! We rode together for most of the first day trading leads, him doing 22 and I puffing at 18-20mph. We penciled in to meet at the Oly Club in Centralia but I suspect his family had other plans so I never saw him again. (If you're out there Jason, thanks for the pulls and may the force be with you, your wife and family! Here's to survivorship!)
We blazed that first day and I made it in five hours and forty three minutes at about 17.5mph average speed. We stayed at Shelly's late Grandpa's house as we do every year so we had all the accoutrements, which included a washing machine, dryer, kitchen and showers. So, I was able to wear my "pink ribbon" jersey again. After missing Jason at the Oly Club, I walked Lisa through the Centralia Community College Campus in hopes that I might bump into Jason somewhere. He was set to camp there overnight. However, Lisa was heartbroken that she couldn't ride this year and started to break down as we wandered throught the campus. She felt she didn't deserve to be there but we all know that's definitely not the case.
The next day was different. I never met back up with Jason. I couriered a wallet for Bill, caught up with Daphne and Steve and just kept going. I wanted to bust 20mph for the rest of the day and did a good number on that goal for the first two hours but by the time I got to Riverside (our lunch break), I started to wane. It was just after 10am or so and I took on as much fuel as I could stand. Still, it took waaay too much energy to pierce the wind solo for so long. I caught up with Bruce just before the Longmont Bridge and then met up with Bob and Dave at the mini stop just past the bridge. I didn't linger though and the day started to warm up quickly. Highway 30 would be cruel at anything over 75 degrees, so I kept pushing onward.
I thought about Lisa not being there; how she's always been there for me. I missed her more and more as the day wore on. Each year, this is always the hardest day for me. I am, as usual, so jacked by our progress the first day that I want a repeat performance the second. But each year, I come to the realization that the "rollers" of the second day have a way of wearing on you. Plus, we never ride more that one century in succession except for the STP. So, unless that changes, I'm guessing the second day of the STP will always be destined to be the dog day of the ride. This year was no different except, I didn't have Lisa Locomotive to pull me in the last 30 or so miles when I'm just whipped like wet rag in the wind.
Lisa was there at the finish line and I was lucky enough to be the first, in front of the peleton of riders I happened to be riding with at the time, to cross finish line. I came in pretty fast with my fist in the air and heard Lisa exclaim, "RANDALL!" as I zipped by. She ran to great me rushing past the masses of family and friends awaiting their respective loved ones. There's no other smile like hers and everytime I see her smile, I feel that way. She gave me a big hug as I collected my "finisher's patch" and we set off for the beer garden.
We ended up having our fair share at the beer garden as the other riders straggled in. We all headed off for showers made reservations for dinner at Stanford's. It wasn't until the next day at breakfast that Lisa got a call from her oncologist to discuss the results of the meeting we had with Dr. Beatty last Thursday. The gist of the conversation was that we were looking at chemotherapy due to mass size alone. The oncogene test may just be an afterthought. Stage Two seems to warrant chemo in lieu of other data. I began thinking how could Lisa possibly do the Ride from Seattle to Vancouver and Party (RSVP) with a chemo port sticking out of her chest?
Size Matters . . . Or Does It? - (7/13/11)
It came to this. It came to steeling ourselves up for the coming news. Intelligence reports were leaning toward chemotherapy. We'd discussed this with Dr. Beatty. He seamed pretty sure we'd be having a cathoder with a port put in to Lisa's chest just below her collar bone. He called Lisa and told her that the oncogene test (actually called an oncotype dx test) had come in and that he'd be faxing it to our oncologist. He also said that if our oncologist told Lisa that she would not need chemotherapy, she should get a second opinion. We ate a quick lunch at the Oak Table in Sequim before our 2:15 appointment. We got onto the subject at hand. I, for the life of me, was trying to figure out what was about to transpire.
Lisa was so upset that she couldn't do the STP for the first time in 7 years, I needed to find a way to break it to her that the RSVP most likely would be out of the question as well. So, as calmly as I could, I mentioned it. And, as if I'd just gently turned a spigot, she welled up and began to cry. It's one of the most beautiful things I see when she cries because she is so tender and precious at those moments. I don't ever want to be the cause, I don't want her to feel bad or get hurt, but her heart is so . . . there at moments like these that I can't help but fall in love with her all over again. She is so strong and yet so tender. She wants to ride! She wants to live! She wants to love! And, she DOES!! I've never found a truer more sincere spirit than hers.
She regrouped after a bit and we ate our lunch and headed to the oncologist's office for our appointment. Even though we had just eaten, I was still on edge. You know, how you just want to bite someone or something when you haven't eaten in while? Something like that. I was angry. I was looking for an excuse just to hit someone or something. I was not looking forward to this meeting. They were going to tell us--what we already knew--that Lisa would have to undergo chemotherapy. It's not the end of the world. But it is a game changer. It's a daunting treatment that lasts for months and has its complications, side effects and can weaken even the strongest of spirits.
Once in the office with our oncologist, we began the talk. The mass was bigger than estimated (2.5cm instead of 1.17cm). The classification gets upgraded to Stage 2A. The decision tree gets narrowed from just radiation to chemotherapy AND radiation (sequentially). Lisa asks if this includes the results from the oncogene test. There's a pause, a shuffle through her file, and a somewhat upbeat, "oncotype test results came back?" Lisa explains what her surgeon stated and her oncologist excused herself to fetch the results. Once back from the fax machine, she explained that this changed her treatment options. Lisa's tumor's DNA scored low for recurrence based on the DNA mutations that were (not?) detected. We went from almost definitely having to have chemo to . . . not so much. We were confused.
The surgeon had stated otherwise. In fact, he specifically stated that if our oncologist said that chemo was not recommended, we should get a second opinion. Our oncologist said, based on the oncogene test, that chemotherapy would only reduce the recurrence potential by 1 - 3 percent. She said that the the oncogene test score was a 15 out of a possible 60. That her likelihood of recurrence was 9%. Lisa asked why our surgeon seemed so adamant about having her treated with chemo? I interjected as well and wanted her to clarify what we were being told. It was then that we got the lowdown from our oncologist's perspective.
She stated that oncogene testing is only about 3 - 4 years old. Lisa had the right parameters for qualifying for oncogene type testing according to insurance company policies (apparently it's expensive as are most DNA type tests). That her initial tumor mass size was initially less than 2cm and her sentinel lymph node(s) came back negative, she was a go for the test. In fact, the oncologist told us that when she called the surgeon, he had asked for a cancellation of the oncogene test (since the ultimate tumor mass size was 2.5cm). Confused yet? This is where I questioned the procedural part of the whole chain of action to date.
That is, the oncologist said that the oncogene test basically trumps the size/stage threshold criteria that triggers the need for chemotherapy. If the test were not performed, Lisa would be slated for chemotherapy due to the size and subsequent stage of the tumor alone. In fact, had the size been remotely measured (e.g., via mammogram, ultrasound, MRI, PEM, etc.) as such, the test would not have been ordered in the first place. This is where I got confused. So, I asked, "if the oncogene test returns a low score for recurrence and the mass is larger than 2cm and that negates the need for 'unnecessary' treatment, why isn't the oncogene test ordered for all tumors?" The answer: it's not within the insurance companies criteria for approved testing. Baffling!
Chemotherapy is a systemic treatment that rifles throughout the entire body and destroys cancer cells WITH collateral damage. Kinda like a carpet bombing campaign with poison gas. We're looking at a four month treatment plan that would not be necessary thanks to relatively recent test that determines recurrence likelihood. I likened the test to being able to determine what type of bad guys we were looking at. Were they regular army, special forces, or peasants with pitch forks. A more broad spectrum analogy would be bread mold typing (e.g., green, white, black, etc.) Each has their relative tenacity for recurrence. In Lisa's case, we're talking peasants with pitch forks or whatever color mold is the least likely to come back.
We should've been overjoyed. We weren't. Our minds were sooo geared for the chemo tract that this threw us for a loop they same way getting told that the "pre-cancer" biopsy was in fact cancer . . . only in reverse. Our oncologist apologized for the confusion and was more than willing to arrange for a second opinion. We deferred to a decision on that a bit later once we had a chance to digest the information we'd just been told. If chemo would only reduce the likelihood of recurrence by 1 - 3 percent, would it really be worth it to undergo 4 months of it? That means she'd be reducing the chance of recurrence from 9% to possibly 8% or, at best, 6%.
To me, this is a quality of life question. If you work with statistics at all for any length of time, you understand that getting hit by a bus, falling in the tub, contracting a disease, etc. are all about as likely and here we're talking about knowns. That is, we know where buses travel and to look before crossing a street, are aware of the hazards of soapy feet in the shower, we are careful to get vaccinated and wash our hands and also know that Lisa has contracted a "garden variety" cancer, the pitch fork festooned peasant variety, for which we've been able to detect, extract and monitor (grammar for you Nicole my apologies if it's still wrong). Do the gains justify the means? It begs the question also, will the insurance company pay for the chemotherapy based on the information at hand? Hmmm . . . ?
So now we've scheduled an appointment for a second opinion just to soothe our pensive, anxious states of mind. I'd also like our surgeon to be convinced but I'd be good with just having the second opinion mimic the first. We'll see. Lisa's scheduled for her second surgery next week. Right now we're looking at radiation treatment four weeks after that for about five weeks. Then she'll be on Tamoxifen for 5 to more likely 10 years (or more) after that. Radiation will nuke the local area and has it's own potential side effects and concerns.
Tamoxifen will address the systemic issue similar to the way chemo would've only with less overall damage to "good" tissue. It will inhibit the estrogen and progesterone for which her tumor tested positive. If I hadn't mentioned this before, some cancer cells grow in faster/stronger/whatever in the presence of estrogen and/or progesterone. Thus, soy or other foods that contain such hormones should be avoided. And, Tamoxifen will inhibit or block the receptors of the tumor cells (and others?) that normally would readily except the hormones and grow. For now the course is toward recission, extraction of more tissue from the lateral area that only had 1mm of clear margin from the tumor followed by radiation and tamoxifen. We'll know more (or less) Monday. Until then, when life throws you hills, shift, stomp and grind!
On the Other Hand . . . (7/21/11)
. . . let's take a look at the BIG picture. Monday came and we ended up back in Seattle's Swedish Medical Center for our second opinion. Dr. Goodman was our oncologist and he began our interview by asking how we got to where we were and what had happened. We filled him in on the nitty gritty details which entailed everything you've just read up to this paragraph. Then he asked whether or not there was any family history. This became a bigger player in our decision making once Lisa listed the members of her family that had contracted various forms of cancer most of which have since passed.
I had just had my annual physical that morning and, now at age 50, I got the colonoscopy talk. Although my family history consiting of my dad--who died at age 60 of lung cancer from smoking cigarettes since before I was born--and his brothers was negative for colon cancer, I decided to schedule a colonoscopy. On my mom's side, the same. The discussion went something like this,
Dr.: "We can see, biopsy, remove and thus cure . . . "
Me: (Thinking about all of the preservatives, addatives, pesticides, herbicides, toxins and chemicals I've unconsciously consumed in my life time that passed through my system) "Let's do it."
Dr. Goodman, after listening and taking notes, began explaining Lisa's prognosis and subsequent successes diagnosis-wise. He mentioned that the BRCA test only tests for the genes they "know of" that are linked to likelihood of contracting cancer. He stated that there is still a lot that they don't know about cancer, leaving the question as to which other genes could be linked thusly that are currently undiscovered. Clearly, it appears that Lisa's case could prove a case in point regarding discovery of another gene that could link genetic likelihood for contracting at least breast cancer. Her mom's a survivor and so is her mom's sister. Her cousin on her father's side contracted it at age 36 and ultimately lost the battle.
(7/24/11) The majority of the rest of her family has passed mostly from lung cancer due to smoking. Had Lisa become a smoker, she'd be at considerably higher risk of contracting lung cancer as well. Of seven aunts and uncles on her father's side, five died of cancer and one is currently a cancer survivor undergoing chemotherapy. Her brother passed at age 41 from massive brain tumors and had cancer distributed throughout his body via the lymphoid system. On her mother's side, besides her mother and aunt, one uncle passed from cancer. Needless to say, we need to take the threat of cancer seriously.
As such, we were initially looking at not going via the chemotherapy route due to some statistical facts. However, Monday night, we came back to Port Angeles and decided to ride up Hurricane Hill Tuesday to ponder the two oncologist's opinions and Lisa's best course of post lumpectomy treatment. I woke up around 4AM and couldn't fall back to sleep thinking about how important this decision was. I began to mull what Dr. Goodman said about the blood stream being a conduit for the spread of cancer when he said that she was negative for cancer in the vessels around her tumor. What if one cell slipped by? Where would it be now? He also mentioned that chemotherapy can reduce large tumors by 50% and works quite well against small populations of cancer to the point of eliminating them. My mind was made up. As painful and horrific as it might be, if there was any way, I'd recommend Lisa undergo chemo.
The Climb
Lisa and I began the ascent to the top of Hurricane Hill around 10:45AM. We were geared and fueled and mentally prepared to climb the 5K feet to the top. We'd take our time and I'd swing back around if I got too far ahead. This ride was about and for Lisa. She wanted to ride it July 2nd. We were going to call it Operation Hurricane in honor of her looming lumpectomy surgery. She wanted to invite as many cycling friends as we could to join us. But, due to rescheduling, she ended up having surgery on June 29th. That left riding up the Hurricane to another day. That day became July 19th, after her first surgery and a mere day before her second. She hadn't made up her mind yet and this was a means to help her think about it and decide. No friends, just us.
The ride started out at a mild 64 degrees F but quickly cooled off as we reached the National Park gate 5 miles up. The sign read "Fog Ahead" and the prediction was damn accurate. We were fairly well soaked with sweat as the first five miles are notoriously the hardest at an average grade of 8%. Once past the gate, the road switches from chip seal to hot mix asphalt--the difference is like riding on frozen gravel then switching to firm felt. The grade also changed from 8% to 6%. And with that, the temp began to plummet to 55 degrees. We donned our sleeves and even our jackets at the first scenic pullout. Then we stopped again to unzip our jacket sleeves and render the windbreakers into vests.
The clouds drifted, sifted by the pines. The three tunnels felt erie and dank and somewhat like giant, ancient and crude MRI tubes. The only light was at the end of each, the only sound, our own breathing and pedalling. It felt like we could lose our souls in there. The mountain was greener than I've ever remembered it, the rock harder somehow. Traffic was light and we were pretty much left alone to conquer the hill that day. We saw a grouse within a meter on the right side of the road then much further up heard and saw another. The bass call of the grouse nearer to the top was in full display on the left side of the road and I made sure to point it out to Lisa.
Lisa was riding strong and steady and we took relatively few breaks as needed. We chatted about the big decision and I commented that family history and potential undetected cancer populations could be eliminated if she chose to go that route. I also mentioned that either decision she made I would stand by her; I'd have her back. She was a littled worried about how others would react. Then she reasoned that she really didn't need to concern herself with that as it was her body and her life in contention here. As the altitude rose to 4,000 feet, the air got thinner and our average speed slipped to a paultry 5mph. I once thought that the mountain kicked up in the last 2 miles to 9% but thanks to my Garmin, I know it stays a steady 6%. The air is what makes it feel like that. Nonetheless, we motored on. We'd shift, stomp and grind our way to the summit.
The clouds cleared near the top and the temp rose to 60 degrees. I had ridden this on the 2nd of July and was ready, this time, for the fact that the finish is never around the corner you think it is. How prophetic, especially on this hill on this day. Lisa's first surgery was a success . . . except that 1mm lateral margin, thus a second "clean up" surgery. We knew that she didn't have to decide today, except we did need to decide whether or not to have the port-a-cath surgically implanted. We got to the top and the sun was out, the deer were . . . there and so were the tourists. The remnant snow went unnoticed, to me. The wind was strong and steady so we ducked behind the hill house and went in to fill our bottles and empty our bladders.
Descent
Back outside, we posed for a quick photo and prepared for our descent. We knew it would be a cool one but what we didn't know was that the clouds had begun to park around the base. It was a cool descent indeed! The tempurature had dropped to a very chilly 50 degrees under the cloud cover and the fog we encountered added to the windchill as we cautiously descended down the mountain. What took us nearly three hours to climb usually would take around 40 minutes to descend however, we had to take a few warm up breaks just to get the feeling back into our fingers so we could brake safely. July, huh? Where?
I had a meeting in town regarding the Nippon rerouting of the Olympic Discovery Trail at 3PM and it was after 2:30 already. I didn't want to miss it but it would be close and I'd just have to ride straight there. Lisa was cold and we both couldn't feel our toes as we zipped by the park entrance gate. We kept on keeping on, doing about 35mph past the Burnt Mountain overpass. It wasn't until then that we could detect the slightest rise of degrees of Fahrenheit and with it, the return of our shadows ever so faint from the filtered sun. Even just one degree felt warmer. But, we still couldn't feel our toes. Finally, at the stop sign at the bottom, we turned onto Race Street then onto Lauridsen. Once at the house, I kissed Lisa a temporary goodbye as she thanked me for the ride and I headed off to my meeting.
Decision
After a shower and a change, we packed our bag and headed to Seattle. On the way, Lisa gave me her decision. She wanted chemotherapy. Even though her recurrence was at 9% and chemo would only knock that down by half, at best, she thought it prudent to hit this thing with everything we have in our arsenal. I concurred. She'd already lost the 1 in 10 women get cancer odds. She was effectively betting the same odds of recurrence, 0.9 (or 1) in 10. We'll take every conceivable advantage afforded us, damn it anyway! Of course, I knew this would entail a lot of suffering on her part, not mine. She'd be the one on the front line of this thing. She'd be embarking on a route that was not clearly marked, well travelled by others, but not by her. Her journey would be as unique as she is and unknown to her. All I can do is be there for her. As much as I wanted her not to suffer, I'd be relegated to holding her hand, standing by her side, wiping her tears and hoping for the best.
We stayed at the Inn at Cherry Hill Campus. The entire city of Seattle was booked on Wednesday and Thursday night due to parent's night/orientation for the UW and other colleges in town. Swedish had converted some rooms in their Cherry Hill Campus hospital into "hotel" rooms. We were lucky to get one. It was however, a hospital room with two twin beds. Nonetheless, we got ready for Lisa's "clean up" surgery the next morning. We headed up Broadway and ate at Julia's then retired shortly after.
Her surgery was scheduled for 10:45AM and we were promptly up and dressed that morning and appeared at the check in by 8:30 per instructions. It was only then that we found out the surgery was bumped to noon. Someone forgot to let us know so we spent the whole day at the hospital waiting room and Lisa didn't get into surgery until 1PM. Dr. Beatty visited us in pre-surgery and explained how we got bumped, something to do with a diabetic patient, etc. He asked what our decision was and upon hearing it and the reasoning, he stated that it was a . . . reasonable decision.
Nancy and Nicole showed up and waited with me while Lisa went in for surgery and the port-a-cath implant. In case I hadn't mentioned it, a port-a-cath is a catheter that gets implanted into one of the arteries close to Lisa's heart and has a port situated near her collar bone that is designed to be easily accessed in order to administer the caustic chemicals of chemo for maximum dilution. The chemicals in chemo are known to be rather irritating via veins and it can be difficult to find good veins to use once treatment continues as the veins tend to become inflammed over time.
We got a little worried once 2:30PM came and went and then finally relieved upon seeing Dr. Beatty stroll into the waiting area just after 3PM to explain how well everything went. She came through like a champ, once again. Nancy had gotten us some dinner for our room and departed once she knew Lisa was in the clear. (Thanks for dinner Nancy). Nicole and I went in and saw to Lisa's recovery when we were allowed. She was actually much better this time around and didn't have any tummy issues like last time. As we exited the hospital, Nicole headed home and Lisa and I headed for the Inn. She was in good spirits and nodded off and on once settled in at our room.
We made it back to Port Angeles the next day without incident. Now it was time to let wounds heal and get Lisa back to strength. She is determined to do the RSVP and had gotten clearence from her doctors that chemo wouldn't have to start until after she heals and after the RSVP on August 5th and 6th.
Meanwhile, while I was washing my bike Kandi yesterday, I noticed a small crack on her chain stay. I took 'er to the bike shop and she was pronounced done on arrival. With a push of the finger on the dime sized crack sight, the carbon fiber of the chain stay mushed down. And that, as my father used to say, was all she wrote. Luckily, Specialized guarantees their frames for life. I'd need a new frame before we leave for the RSVP. Until then, pins and needles for a bike.
Two Degrees from Normal (8/20/11)
The bike frame came in, the ride went down in epic style and we returned to, in the words of Pete Townsend, "give blood and face the face" (so to speak). Actually, Lisa would be the one to do all that. I on the other hand, would be on hand to hold her . . . hand and wipe her tears, etc. We had gone to Lisa's Chemo consultation the week we were to embark on our RSVP event bike ride. Lisa (and I) were told that Chemo kills any fast growing cells in her body specifically because cancer cells are of the fast growing variety. Because of this, her hair would start to fall out in two weeks time, the cells in her mouth, finger nails and toe nails, gastro-intestinal cells, white blood cells and . . . anywhere any cells tend to be fast growing would also perish.
Well, we got back from our ride from Seattle to Vancouver to Victoria on Monday and Lisa started Chemo on Tuesday, the 9th of August. She had to take a pill the day before and take one the day after, plus a shot to boost her white blood cell count. In fact, she's taking several other drugs to counter the effects of Chemo and some to counter the side effects of the drugs she's taking for the drugs she's taking to counter the side effects of those other drugs. It makes your head spin. It makes her head spin and she's taking a drug to counter that effect as well.
After the initial dose of Chemo, we carried on our way, anticipating and anxious about how her body would react. Day two rolls by and she's doing fine. It's as if nothing is happening or has. Day three and four roll by and aside from some restless sleep (for which she has a pill) everything appears normal. She did feel a tad punky and her taste for things changed. She didn't like wine or beer or coffee or much of anything except ice cream and milk and water. It wasn't until Sunday night where she started to heat up. The nurse and oncologists were very specific about her temperature. She was to call immediately if her temperature exceeded 100.4 degrees Farenheit. That's less than two degrees from normal (98.6).
I have to admit, when Lisa called down to the basement that her temp was 100.5, all I said was take some Tylenol. She called. It was 7:30 PM on a Sunday night and the on call oncologist told her to go to the emergency ward at the hospital and tell them that she's a breast cancer patient with a fever of 100.5. Grudgingly, I got the keys and escorted Lisa to the emergency room. My experiences at the emergency room to date have been an agonizing excersize in patience. If you're not dying, you're waiting three hours of your life to find out what's wrong with you. And, usually your in some uncomfortable room sitting on some uncomfortable, wrinkley surface wearing that awkward gown and wondering if we pay these people by the hour.
We were finally seen by the receptionist, then an hour later by a nurse, then an hour later by a phlebotomist, then an hour later by the doctor (or at least it seemed to take that long). By the end of the night, literally, we were told Lisa's white blood cell count was dangerously low. First we were told it was 1500 when her last count before Chemo was 9000. Then we were told it was 1.5. Umm . . . yeah, I had to ask why the discrepency with the numbering. We were told that 1.5 meant 150 and that 300 was considered low. Then we were told that they were just referencing the white blood cells that actually fight infection. In any event, her count was low and she was spending the night at the hospital. It was past midnight.
Lisa was immediately put on antibiotics every 8 hours. She was admitted to her room and hooked up to an IV. We asked if I could stay with her that night and arrangements were made to put a "chair" that folds out in origamic fashion into a sleepless torture machine. Lisa's bed could be contorted into something resembling the petals of a rose with the push of several buttons if one wasn't careful. Seriously though, let's face it, once I found out about the white blood cell count, I was in a mild form of shock how dangerous two degrees from normal turned out to be. My comfort was the last thing on my mind that night. The gentleman hacking up a lung across the hall from us kept us in touch with reality. We were in a hospital, again. That's twice in two years.
(8/30/11) All in all, we survived that night. Lisa had to stay another night and she insisted I go home and get some rest. The next day she was released as her white blood count rebounded to normal and as soon as the last of her antibiotics were administered. Well, guess we weren't going to the County Fair or Bumbershoot this year. Guess we weren't going out much at all. Going to her family reunion that weekend wasn't the smartest thing we ever did and neither was letting the grand neice and nephew stay over that Saturday night. We immediately ceased and desisted any and all public functions and/or visitations. Her and I certainly didn't want to experience anymore hospital time than was absolutely necessary.
THANK YOU! (8/30/11)
When we got back to normal, or at least a cloistered version of it, we began to settle into a quiet routine. We've had such marvelous and generous support from our friends in the form of dinner deliveries and even some much needed cold hard cash! I can't say enough how much these actions have warmed our hearts. The early chapters of this episode had us going to Seattle quite alot and often overnight. That put a dip in our finances that we hadn't quite anticipated. It was extremely pleasent to receive a most unexpected gift of dollars from an anonymous source. So if you or those of you are reading this, THANK YOU DEARLY for your magnificent generousity. Don't be shy to ask the same of us when you need it.
The dinners have been a blessing as well. It has been nice to offset the expense of dinner with this much welcomed gift by our local community of friends and family. And by "expense" I also mean the time involved in planning and preparing that a meal often takes. It's one less thing we need to worry about during several days of a given week. Often there is more than we can eat in a night and it serves us as leftovers for following nights. THANK YOU as well! It's been delicious!
"The Hair, the Hair . . . " (8/31/11)
By week two of Lisa's first round of Chemo, she started feeling much better but her taste had gone caddywhompus. Still, she's enjoyed the meals delivered to us with a new understanding of texture. Before Chemo, texture was a pleasant adventure, now she enjoys "smooth" foods at an elevated level. As week three rolled around she was nearly back to her old self until the morning, in the shower, when she reached out to me with tears in her eyes and a large, stringy, wet clump of her own hair in her hand.
You can say you're mentally ready for something; jumping out of a perfectly good airplane, off of a cliff with nothing but a rope or hang glider between you and certain death, you moving back in with your parents, one of your parents moving in with you, etc. But when it's your own hair leaving you en masse, that's not an easy one to take. The mass exodus of Lisa's hair shook her. It was nothing less than the physical manifestation of what her body had been going through to date with little more than a slight fever and some taste issues to show for it until the hair thing.
To a woman, hair is something special. Even us latter day baby boomer males know what a "freak flag" means to us. It's a symbol. Symbols can mean many things, freak flags were a symbol of antiestablishmentarianism or a way to get under the skin of our parents. For women, it's about beauty and attraction . . . and self esteem (at least that's my male perspective on it). If you've ever seen Lisa's hair up close and personal, it was breath taking. Naturally curly with natural highlights of auburn, brunette and . . . what I call platinum blonde (gray), it was an envious head of hair to behold.
Seeing the shower scene trauma, I immediately but gently began lobbying for cutting it. That afternoon, we were both sporting shaved heads. I went first (to show her how it's done) and she followed with tears flowing. Tammy at Hair Solutions mentioned how hard it was to cut someone's hair with tears in her eyes. Tammy then gave us access to Operation Uplift's bevvy of hats and wigs so Lisa could pick out something she could sport now that she could no longer "sport" her own hair. It took a few days, but by the end of a couple of days, she was feeling better and feeling better about her hair situation too.
Since then, she's been getting rave reviews about the shape of her head and how beautiful she is. (I could have told them that!) I knew all along. She's since embraced her new look and started wearing earings and even losing (not wearing) the hats. The air is definitely cool on her unprocected, nubile scalp. I've even gone so far as to close/razor shave my scalp. I just didn't wan't her to feel completely isolated.
"DING DING" Round Two (8/31/11)
Yesterday, we went in for round two. I was sure to let our oncologist know what happened last time. I want to be sure to avoid going to the emergency room again. Dr. Nellie mentioned that she was not pleased with the admittance. She thought it could've been handled with an at home regimen of antibiotics. So, with new instructions on when to call in the case of a low grade fever (after repeated temperature readings on two hour intervals) we went in and Lisa got "ported" into the Chemo Zone.
The Chemo Treadmill (10/3/11)
Well, the story to date follows a pattern of sorts:
When Life Gives You Hills . . . SHIFT, STOMP & GRIND! - (7/11/11)
We just got back from the Group Health sponsored, Cascade Bicycle Club run Seattle to Portland (STP) Bike Ride. It has become an annual event for Lisa and I since 2005. The ride itself has been held since 1979 (the year I graduated from high school) with the exception of 1980 when Mt. St. Helens blew. After much distress and forethought, Lisa decided not to ride the STP this year. Her lymph node incision has given her some pain and the thought of riding 204 miles in two days with any other pain than the usual nails in the butt, knees of rusting bolts and broken glass, feet on fire, torture rack back, general numbness in any or all of the five points of contact on a bike would not be welcome/warranted/etc. I believe it was the best decision. The jarring of the roadway with fresh surgical incisions did not sound . . . sound to me.
We headed to Seattle on Thursday to meet with Dr. Beatty to discuss the post operation details. Funny how it is, that the one thing you overlook or forget about always comes back to bite you in the ass! This very thing happened upon meeting with Dr. Beatty Thursday afternoon. When they take out a cancerous mass from the breast, they take more than just the area they can see/detect. I believe they use a radioactive die to "light up" the tumor and take a certain percentage or "margin" of tissue around said mass. I (we) kinda forgot about the fact that they examine this margin area microscopically to determine proximal limits. That is, how far are there "cancer free" cells from the cancerous ones in the tissue that they surgically extracted.
That is what the meeting with Dr. Beatty on Thursday afternoon in Seattle was all about. The pathological report on the margin tissue came back. Lisa was free and clear by 10mm on all axis of the tissue except the lateral area. This was only 1mm clear of cancer. Remember when your little sibling didn't want any of their food on their dinner plate to touch? Even if it was just the juice from the green beans or the gravy or the meat, it became detestable to them? Well, this was like that only on a mortal scale. Translation: Lisa will have to go under the knife one more time to remove more tissue in the lateral region and have it tested to confirm she is indeed free and clear of any malingering cancer cells beyond the prior 1mm margin. Hey, if you're clearing a minefield, you wanna be doubly sure it is indeed clear of mines!
Oh, and did I mention that they found the cancerous mass to be twice the size that they could detect with all of those detection methods I mentioned earlier? Yeah, well, yeah, almost exactly that is what happened. They found the mass to be 2.5cm! That means the "early on set Stage One" gets reclassified to "Stage Two". Which, by the way, means that we now have to seriously consider chemo-therapy. I can't put into words how this made us feel. Dr. Beatty made sure to schedule the rescission/surgery so that once the oncogene dx test comes back, we'd have all the data we needed to determine whether or not to proceed with putting a surgical port into Lisa so that the chemotherapy could more readily and conveniently be administered. The surgery is scheduled for the 20th of July. We've a meeting with Lisa's oncologist on the 18th.
I rode the STP while Lisa rode with Reenie down to Centralia on the first day and then to Portland on the second day. It was perfect weather, cool in the morning and warming much later in the afternoon. The skies were clear the first day and partially cloudy the second but by the afternoon, the sun came out in force. The first day, I met a guy who struck up a conversation with me just past the University Bridge. He rode strong and fast and I tagged along as best I could but by the first incline of any significance, his higher thrust to weight ratio dropped me. Funny thing though, I ended up bumping into him several times after each time I got dropped due to the hills.
His name was/is Jason. We chatted about how often we'd ridden the STP and, of course, I had to mention that my wife usually accompanies me on these and that this was the first year she would not be and why. As it turns out, his wife had undergone a similar scenario via lumpectomy, etc. and that she ultimately had to opt for a double mastectomy. Perhaps he was drawn to the giant pink ribbon I brandished on my George Hincapie jersey we bought to signify our struggle. He is from Vashon Island and ride the flats at a blistering 22mph! We rode together for most of the first day trading leads, him doing 22 and I puffing at 18-20mph. We penciled in to meet at the Oly Club in Centralia but I suspect his family had other plans so I never saw him again. (If you're out there Jason, thanks for the pulls and may the force be with you, your wife and family! Here's to survivorship!)
We blazed that first day and I made it in five hours and forty three minutes at about 17.5mph average speed. We stayed at Shelly's late Grandpa's house as we do every year so we had all the accoutrements, which included a washing machine, dryer, kitchen and showers. So, I was able to wear my "pink ribbon" jersey again. After missing Jason at the Oly Club, I walked Lisa through the Centralia Community College Campus in hopes that I might bump into Jason somewhere. He was set to camp there overnight. However, Lisa was heartbroken that she couldn't ride this year and started to break down as we wandered throught the campus. She felt she didn't deserve to be there but we all know that's definitely not the case.
The next day was different. I never met back up with Jason. I couriered a wallet for Bill, caught up with Daphne and Steve and just kept going. I wanted to bust 20mph for the rest of the day and did a good number on that goal for the first two hours but by the time I got to Riverside (our lunch break), I started to wane. It was just after 10am or so and I took on as much fuel as I could stand. Still, it took waaay too much energy to pierce the wind solo for so long. I caught up with Bruce just before the Longmont Bridge and then met up with Bob and Dave at the mini stop just past the bridge. I didn't linger though and the day started to warm up quickly. Highway 30 would be cruel at anything over 75 degrees, so I kept pushing onward.
I thought about Lisa not being there; how she's always been there for me. I missed her more and more as the day wore on. Each year, this is always the hardest day for me. I am, as usual, so jacked by our progress the first day that I want a repeat performance the second. But each year, I come to the realization that the "rollers" of the second day have a way of wearing on you. Plus, we never ride more that one century in succession except for the STP. So, unless that changes, I'm guessing the second day of the STP will always be destined to be the dog day of the ride. This year was no different except, I didn't have Lisa Locomotive to pull me in the last 30 or so miles when I'm just whipped like wet rag in the wind.
Lisa was there at the finish line and I was lucky enough to be the first, in front of the peleton of riders I happened to be riding with at the time, to cross finish line. I came in pretty fast with my fist in the air and heard Lisa exclaim, "RANDALL!" as I zipped by. She ran to great me rushing past the masses of family and friends awaiting their respective loved ones. There's no other smile like hers and everytime I see her smile, I feel that way. She gave me a big hug as I collected my "finisher's patch" and we set off for the beer garden.
We ended up having our fair share at the beer garden as the other riders straggled in. We all headed off for showers made reservations for dinner at Stanford's. It wasn't until the next day at breakfast that Lisa got a call from her oncologist to discuss the results of the meeting we had with Dr. Beatty last Thursday. The gist of the conversation was that we were looking at chemotherapy due to mass size alone. The oncogene test may just be an afterthought. Stage Two seems to warrant chemo in lieu of other data. I began thinking how could Lisa possibly do the Ride from Seattle to Vancouver and Party (RSVP) with a chemo port sticking out of her chest?
Size Matters . . . Or Does It? - (7/13/11)
It came to this. It came to steeling ourselves up for the coming news. Intelligence reports were leaning toward chemotherapy. We'd discussed this with Dr. Beatty. He seamed pretty sure we'd be having a cathoder with a port put in to Lisa's chest just below her collar bone. He called Lisa and told her that the oncogene test (actually called an oncotype dx test) had come in and that he'd be faxing it to our oncologist. He also said that if our oncologist told Lisa that she would not need chemotherapy, she should get a second opinion. We ate a quick lunch at the Oak Table in Sequim before our 2:15 appointment. We got onto the subject at hand. I, for the life of me, was trying to figure out what was about to transpire.
Lisa was so upset that she couldn't do the STP for the first time in 7 years, I needed to find a way to break it to her that the RSVP most likely would be out of the question as well. So, as calmly as I could, I mentioned it. And, as if I'd just gently turned a spigot, she welled up and began to cry. It's one of the most beautiful things I see when she cries because she is so tender and precious at those moments. I don't ever want to be the cause, I don't want her to feel bad or get hurt, but her heart is so . . . there at moments like these that I can't help but fall in love with her all over again. She is so strong and yet so tender. She wants to ride! She wants to live! She wants to love! And, she DOES!! I've never found a truer more sincere spirit than hers.
She regrouped after a bit and we ate our lunch and headed to the oncologist's office for our appointment. Even though we had just eaten, I was still on edge. You know, how you just want to bite someone or something when you haven't eaten in while? Something like that. I was angry. I was looking for an excuse just to hit someone or something. I was not looking forward to this meeting. They were going to tell us--what we already knew--that Lisa would have to undergo chemotherapy. It's not the end of the world. But it is a game changer. It's a daunting treatment that lasts for months and has its complications, side effects and can weaken even the strongest of spirits.
Once in the office with our oncologist, we began the talk. The mass was bigger than estimated (2.5cm instead of 1.17cm). The classification gets upgraded to Stage 2A. The decision tree gets narrowed from just radiation to chemotherapy AND radiation (sequentially). Lisa asks if this includes the results from the oncogene test. There's a pause, a shuffle through her file, and a somewhat upbeat, "oncotype test results came back?" Lisa explains what her surgeon stated and her oncologist excused herself to fetch the results. Once back from the fax machine, she explained that this changed her treatment options. Lisa's tumor's DNA scored low for recurrence based on the DNA mutations that were (not?) detected. We went from almost definitely having to have chemo to . . . not so much. We were confused.
The surgeon had stated otherwise. In fact, he specifically stated that if our oncologist said that chemo was not recommended, we should get a second opinion. Our oncologist said, based on the oncogene test, that chemotherapy would only reduce the recurrence potential by 1 - 3 percent. She said that the the oncogene test score was a 15 out of a possible 60. That her likelihood of recurrence was 9%. Lisa asked why our surgeon seemed so adamant about having her treated with chemo? I interjected as well and wanted her to clarify what we were being told. It was then that we got the lowdown from our oncologist's perspective.
She stated that oncogene testing is only about 3 - 4 years old. Lisa had the right parameters for qualifying for oncogene type testing according to insurance company policies (apparently it's expensive as are most DNA type tests). That her initial tumor mass size was initially less than 2cm and her sentinel lymph node(s) came back negative, she was a go for the test. In fact, the oncologist told us that when she called the surgeon, he had asked for a cancellation of the oncogene test (since the ultimate tumor mass size was 2.5cm). Confused yet? This is where I questioned the procedural part of the whole chain of action to date.
That is, the oncologist said that the oncogene test basically trumps the size/stage threshold criteria that triggers the need for chemotherapy. If the test were not performed, Lisa would be slated for chemotherapy due to the size and subsequent stage of the tumor alone. In fact, had the size been remotely measured (e.g., via mammogram, ultrasound, MRI, PEM, etc.) as such, the test would not have been ordered in the first place. This is where I got confused. So, I asked, "if the oncogene test returns a low score for recurrence and the mass is larger than 2cm and that negates the need for 'unnecessary' treatment, why isn't the oncogene test ordered for all tumors?" The answer: it's not within the insurance companies criteria for approved testing. Baffling!
Chemotherapy is a systemic treatment that rifles throughout the entire body and destroys cancer cells WITH collateral damage. Kinda like a carpet bombing campaign with poison gas. We're looking at a four month treatment plan that would not be necessary thanks to relatively recent test that determines recurrence likelihood. I likened the test to being able to determine what type of bad guys we were looking at. Were they regular army, special forces, or peasants with pitch forks. A more broad spectrum analogy would be bread mold typing (e.g., green, white, black, etc.) Each has their relative tenacity for recurrence. In Lisa's case, we're talking peasants with pitch forks or whatever color mold is the least likely to come back.
We should've been overjoyed. We weren't. Our minds were sooo geared for the chemo tract that this threw us for a loop they same way getting told that the "pre-cancer" biopsy was in fact cancer . . . only in reverse. Our oncologist apologized for the confusion and was more than willing to arrange for a second opinion. We deferred to a decision on that a bit later once we had a chance to digest the information we'd just been told. If chemo would only reduce the likelihood of recurrence by 1 - 3 percent, would it really be worth it to undergo 4 months of it? That means she'd be reducing the chance of recurrence from 9% to possibly 8% or, at best, 6%.
To me, this is a quality of life question. If you work with statistics at all for any length of time, you understand that getting hit by a bus, falling in the tub, contracting a disease, etc. are all about as likely and here we're talking about knowns. That is, we know where buses travel and to look before crossing a street, are aware of the hazards of soapy feet in the shower, we are careful to get vaccinated and wash our hands and also know that Lisa has contracted a "garden variety" cancer, the pitch fork festooned peasant variety, for which we've been able to detect, extract and monitor (grammar for you Nicole my apologies if it's still wrong). Do the gains justify the means? It begs the question also, will the insurance company pay for the chemotherapy based on the information at hand? Hmmm . . . ?
So now we've scheduled an appointment for a second opinion just to soothe our pensive, anxious states of mind. I'd also like our surgeon to be convinced but I'd be good with just having the second opinion mimic the first. We'll see. Lisa's scheduled for her second surgery next week. Right now we're looking at radiation treatment four weeks after that for about five weeks. Then she'll be on Tamoxifen for 5 to more likely 10 years (or more) after that. Radiation will nuke the local area and has it's own potential side effects and concerns.
Tamoxifen will address the systemic issue similar to the way chemo would've only with less overall damage to "good" tissue. It will inhibit the estrogen and progesterone for which her tumor tested positive. If I hadn't mentioned this before, some cancer cells grow in faster/stronger/whatever in the presence of estrogen and/or progesterone. Thus, soy or other foods that contain such hormones should be avoided. And, Tamoxifen will inhibit or block the receptors of the tumor cells (and others?) that normally would readily except the hormones and grow. For now the course is toward recission, extraction of more tissue from the lateral area that only had 1mm of clear margin from the tumor followed by radiation and tamoxifen. We'll know more (or less) Monday. Until then, when life throws you hills, shift, stomp and grind!
On the Other Hand . . . (7/21/11)
. . . let's take a look at the BIG picture. Monday came and we ended up back in Seattle's Swedish Medical Center for our second opinion. Dr. Goodman was our oncologist and he began our interview by asking how we got to where we were and what had happened. We filled him in on the nitty gritty details which entailed everything you've just read up to this paragraph. Then he asked whether or not there was any family history. This became a bigger player in our decision making once Lisa listed the members of her family that had contracted various forms of cancer most of which have since passed.
I had just had my annual physical that morning and, now at age 50, I got the colonoscopy talk. Although my family history consiting of my dad--who died at age 60 of lung cancer from smoking cigarettes since before I was born--and his brothers was negative for colon cancer, I decided to schedule a colonoscopy. On my mom's side, the same. The discussion went something like this,
Dr.: "We can see, biopsy, remove and thus cure . . . "
Me: (Thinking about all of the preservatives, addatives, pesticides, herbicides, toxins and chemicals I've unconsciously consumed in my life time that passed through my system) "Let's do it."
Dr. Goodman, after listening and taking notes, began explaining Lisa's prognosis and subsequent successes diagnosis-wise. He mentioned that the BRCA test only tests for the genes they "know of" that are linked to likelihood of contracting cancer. He stated that there is still a lot that they don't know about cancer, leaving the question as to which other genes could be linked thusly that are currently undiscovered. Clearly, it appears that Lisa's case could prove a case in point regarding discovery of another gene that could link genetic likelihood for contracting at least breast cancer. Her mom's a survivor and so is her mom's sister. Her cousin on her father's side contracted it at age 36 and ultimately lost the battle.
(7/24/11) The majority of the rest of her family has passed mostly from lung cancer due to smoking. Had Lisa become a smoker, she'd be at considerably higher risk of contracting lung cancer as well. Of seven aunts and uncles on her father's side, five died of cancer and one is currently a cancer survivor undergoing chemotherapy. Her brother passed at age 41 from massive brain tumors and had cancer distributed throughout his body via the lymphoid system. On her mother's side, besides her mother and aunt, one uncle passed from cancer. Needless to say, we need to take the threat of cancer seriously.
As such, we were initially looking at not going via the chemotherapy route due to some statistical facts. However, Monday night, we came back to Port Angeles and decided to ride up Hurricane Hill Tuesday to ponder the two oncologist's opinions and Lisa's best course of post lumpectomy treatment. I woke up around 4AM and couldn't fall back to sleep thinking about how important this decision was. I began to mull what Dr. Goodman said about the blood stream being a conduit for the spread of cancer when he said that she was negative for cancer in the vessels around her tumor. What if one cell slipped by? Where would it be now? He also mentioned that chemotherapy can reduce large tumors by 50% and works quite well against small populations of cancer to the point of eliminating them. My mind was made up. As painful and horrific as it might be, if there was any way, I'd recommend Lisa undergo chemo.
The Climb
Lisa and I began the ascent to the top of Hurricane Hill around 10:45AM. We were geared and fueled and mentally prepared to climb the 5K feet to the top. We'd take our time and I'd swing back around if I got too far ahead. This ride was about and for Lisa. She wanted to ride it July 2nd. We were going to call it Operation Hurricane in honor of her looming lumpectomy surgery. She wanted to invite as many cycling friends as we could to join us. But, due to rescheduling, she ended up having surgery on June 29th. That left riding up the Hurricane to another day. That day became July 19th, after her first surgery and a mere day before her second. She hadn't made up her mind yet and this was a means to help her think about it and decide. No friends, just us.
The ride started out at a mild 64 degrees F but quickly cooled off as we reached the National Park gate 5 miles up. The sign read "Fog Ahead" and the prediction was damn accurate. We were fairly well soaked with sweat as the first five miles are notoriously the hardest at an average grade of 8%. Once past the gate, the road switches from chip seal to hot mix asphalt--the difference is like riding on frozen gravel then switching to firm felt. The grade also changed from 8% to 6%. And with that, the temp began to plummet to 55 degrees. We donned our sleeves and even our jackets at the first scenic pullout. Then we stopped again to unzip our jacket sleeves and render the windbreakers into vests.
The clouds drifted, sifted by the pines. The three tunnels felt erie and dank and somewhat like giant, ancient and crude MRI tubes. The only light was at the end of each, the only sound, our own breathing and pedalling. It felt like we could lose our souls in there. The mountain was greener than I've ever remembered it, the rock harder somehow. Traffic was light and we were pretty much left alone to conquer the hill that day. We saw a grouse within a meter on the right side of the road then much further up heard and saw another. The bass call of the grouse nearer to the top was in full display on the left side of the road and I made sure to point it out to Lisa.
Lisa was riding strong and steady and we took relatively few breaks as needed. We chatted about the big decision and I commented that family history and potential undetected cancer populations could be eliminated if she chose to go that route. I also mentioned that either decision she made I would stand by her; I'd have her back. She was a littled worried about how others would react. Then she reasoned that she really didn't need to concern herself with that as it was her body and her life in contention here. As the altitude rose to 4,000 feet, the air got thinner and our average speed slipped to a paultry 5mph. I once thought that the mountain kicked up in the last 2 miles to 9% but thanks to my Garmin, I know it stays a steady 6%. The air is what makes it feel like that. Nonetheless, we motored on. We'd shift, stomp and grind our way to the summit.
The clouds cleared near the top and the temp rose to 60 degrees. I had ridden this on the 2nd of July and was ready, this time, for the fact that the finish is never around the corner you think it is. How prophetic, especially on this hill on this day. Lisa's first surgery was a success . . . except that 1mm lateral margin, thus a second "clean up" surgery. We knew that she didn't have to decide today, except we did need to decide whether or not to have the port-a-cath surgically implanted. We got to the top and the sun was out, the deer were . . . there and so were the tourists. The remnant snow went unnoticed, to me. The wind was strong and steady so we ducked behind the hill house and went in to fill our bottles and empty our bladders.
Descent
Back outside, we posed for a quick photo and prepared for our descent. We knew it would be a cool one but what we didn't know was that the clouds had begun to park around the base. It was a cool descent indeed! The tempurature had dropped to a very chilly 50 degrees under the cloud cover and the fog we encountered added to the windchill as we cautiously descended down the mountain. What took us nearly three hours to climb usually would take around 40 minutes to descend however, we had to take a few warm up breaks just to get the feeling back into our fingers so we could brake safely. July, huh? Where?
I had a meeting in town regarding the Nippon rerouting of the Olympic Discovery Trail at 3PM and it was after 2:30 already. I didn't want to miss it but it would be close and I'd just have to ride straight there. Lisa was cold and we both couldn't feel our toes as we zipped by the park entrance gate. We kept on keeping on, doing about 35mph past the Burnt Mountain overpass. It wasn't until then that we could detect the slightest rise of degrees of Fahrenheit and with it, the return of our shadows ever so faint from the filtered sun. Even just one degree felt warmer. But, we still couldn't feel our toes. Finally, at the stop sign at the bottom, we turned onto Race Street then onto Lauridsen. Once at the house, I kissed Lisa a temporary goodbye as she thanked me for the ride and I headed off to my meeting.
Decision
After a shower and a change, we packed our bag and headed to Seattle. On the way, Lisa gave me her decision. She wanted chemotherapy. Even though her recurrence was at 9% and chemo would only knock that down by half, at best, she thought it prudent to hit this thing with everything we have in our arsenal. I concurred. She'd already lost the 1 in 10 women get cancer odds. She was effectively betting the same odds of recurrence, 0.9 (or 1) in 10. We'll take every conceivable advantage afforded us, damn it anyway! Of course, I knew this would entail a lot of suffering on her part, not mine. She'd be the one on the front line of this thing. She'd be embarking on a route that was not clearly marked, well travelled by others, but not by her. Her journey would be as unique as she is and unknown to her. All I can do is be there for her. As much as I wanted her not to suffer, I'd be relegated to holding her hand, standing by her side, wiping her tears and hoping for the best.
We stayed at the Inn at Cherry Hill Campus. The entire city of Seattle was booked on Wednesday and Thursday night due to parent's night/orientation for the UW and other colleges in town. Swedish had converted some rooms in their Cherry Hill Campus hospital into "hotel" rooms. We were lucky to get one. It was however, a hospital room with two twin beds. Nonetheless, we got ready for Lisa's "clean up" surgery the next morning. We headed up Broadway and ate at Julia's then retired shortly after.
Her surgery was scheduled for 10:45AM and we were promptly up and dressed that morning and appeared at the check in by 8:30 per instructions. It was only then that we found out the surgery was bumped to noon. Someone forgot to let us know so we spent the whole day at the hospital waiting room and Lisa didn't get into surgery until 1PM. Dr. Beatty visited us in pre-surgery and explained how we got bumped, something to do with a diabetic patient, etc. He asked what our decision was and upon hearing it and the reasoning, he stated that it was a . . . reasonable decision.
Nancy and Nicole showed up and waited with me while Lisa went in for surgery and the port-a-cath implant. In case I hadn't mentioned it, a port-a-cath is a catheter that gets implanted into one of the arteries close to Lisa's heart and has a port situated near her collar bone that is designed to be easily accessed in order to administer the caustic chemicals of chemo for maximum dilution. The chemicals in chemo are known to be rather irritating via veins and it can be difficult to find good veins to use once treatment continues as the veins tend to become inflammed over time.
We got a little worried once 2:30PM came and went and then finally relieved upon seeing Dr. Beatty stroll into the waiting area just after 3PM to explain how well everything went. She came through like a champ, once again. Nancy had gotten us some dinner for our room and departed once she knew Lisa was in the clear. (Thanks for dinner Nancy). Nicole and I went in and saw to Lisa's recovery when we were allowed. She was actually much better this time around and didn't have any tummy issues like last time. As we exited the hospital, Nicole headed home and Lisa and I headed for the Inn. She was in good spirits and nodded off and on once settled in at our room.
We made it back to Port Angeles the next day without incident. Now it was time to let wounds heal and get Lisa back to strength. She is determined to do the RSVP and had gotten clearence from her doctors that chemo wouldn't have to start until after she heals and after the RSVP on August 5th and 6th.
Meanwhile, while I was washing my bike Kandi yesterday, I noticed a small crack on her chain stay. I took 'er to the bike shop and she was pronounced done on arrival. With a push of the finger on the dime sized crack sight, the carbon fiber of the chain stay mushed down. And that, as my father used to say, was all she wrote. Luckily, Specialized guarantees their frames for life. I'd need a new frame before we leave for the RSVP. Until then, pins and needles for a bike.
Two Degrees from Normal (8/20/11)
The bike frame came in, the ride went down in epic style and we returned to, in the words of Pete Townsend, "give blood and face the face" (so to speak). Actually, Lisa would be the one to do all that. I on the other hand, would be on hand to hold her . . . hand and wipe her tears, etc. We had gone to Lisa's Chemo consultation the week we were to embark on our RSVP event bike ride. Lisa (and I) were told that Chemo kills any fast growing cells in her body specifically because cancer cells are of the fast growing variety. Because of this, her hair would start to fall out in two weeks time, the cells in her mouth, finger nails and toe nails, gastro-intestinal cells, white blood cells and . . . anywhere any cells tend to be fast growing would also perish.
Well, we got back from our ride from Seattle to Vancouver to Victoria on Monday and Lisa started Chemo on Tuesday, the 9th of August. She had to take a pill the day before and take one the day after, plus a shot to boost her white blood cell count. In fact, she's taking several other drugs to counter the effects of Chemo and some to counter the side effects of the drugs she's taking for the drugs she's taking to counter the side effects of those other drugs. It makes your head spin. It makes her head spin and she's taking a drug to counter that effect as well.
After the initial dose of Chemo, we carried on our way, anticipating and anxious about how her body would react. Day two rolls by and she's doing fine. It's as if nothing is happening or has. Day three and four roll by and aside from some restless sleep (for which she has a pill) everything appears normal. She did feel a tad punky and her taste for things changed. She didn't like wine or beer or coffee or much of anything except ice cream and milk and water. It wasn't until Sunday night where she started to heat up. The nurse and oncologists were very specific about her temperature. She was to call immediately if her temperature exceeded 100.4 degrees Farenheit. That's less than two degrees from normal (98.6).
I have to admit, when Lisa called down to the basement that her temp was 100.5, all I said was take some Tylenol. She called. It was 7:30 PM on a Sunday night and the on call oncologist told her to go to the emergency ward at the hospital and tell them that she's a breast cancer patient with a fever of 100.5. Grudgingly, I got the keys and escorted Lisa to the emergency room. My experiences at the emergency room to date have been an agonizing excersize in patience. If you're not dying, you're waiting three hours of your life to find out what's wrong with you. And, usually your in some uncomfortable room sitting on some uncomfortable, wrinkley surface wearing that awkward gown and wondering if we pay these people by the hour.
We were finally seen by the receptionist, then an hour later by a nurse, then an hour later by a phlebotomist, then an hour later by the doctor (or at least it seemed to take that long). By the end of the night, literally, we were told Lisa's white blood cell count was dangerously low. First we were told it was 1500 when her last count before Chemo was 9000. Then we were told it was 1.5. Umm . . . yeah, I had to ask why the discrepency with the numbering. We were told that 1.5 meant 150 and that 300 was considered low. Then we were told that they were just referencing the white blood cells that actually fight infection. In any event, her count was low and she was spending the night at the hospital. It was past midnight.
Lisa was immediately put on antibiotics every 8 hours. She was admitted to her room and hooked up to an IV. We asked if I could stay with her that night and arrangements were made to put a "chair" that folds out in origamic fashion into a sleepless torture machine. Lisa's bed could be contorted into something resembling the petals of a rose with the push of several buttons if one wasn't careful. Seriously though, let's face it, once I found out about the white blood cell count, I was in a mild form of shock how dangerous two degrees from normal turned out to be. My comfort was the last thing on my mind that night. The gentleman hacking up a lung across the hall from us kept us in touch with reality. We were in a hospital, again. That's twice in two years.
(8/30/11) All in all, we survived that night. Lisa had to stay another night and she insisted I go home and get some rest. The next day she was released as her white blood count rebounded to normal and as soon as the last of her antibiotics were administered. Well, guess we weren't going to the County Fair or Bumbershoot this year. Guess we weren't going out much at all. Going to her family reunion that weekend wasn't the smartest thing we ever did and neither was letting the grand neice and nephew stay over that Saturday night. We immediately ceased and desisted any and all public functions and/or visitations. Her and I certainly didn't want to experience anymore hospital time than was absolutely necessary.
THANK YOU! (8/30/11)
When we got back to normal, or at least a cloistered version of it, we began to settle into a quiet routine. We've had such marvelous and generous support from our friends in the form of dinner deliveries and even some much needed cold hard cash! I can't say enough how much these actions have warmed our hearts. The early chapters of this episode had us going to Seattle quite alot and often overnight. That put a dip in our finances that we hadn't quite anticipated. It was extremely pleasent to receive a most unexpected gift of dollars from an anonymous source. So if you or those of you are reading this, THANK YOU DEARLY for your magnificent generousity. Don't be shy to ask the same of us when you need it.
The dinners have been a blessing as well. It has been nice to offset the expense of dinner with this much welcomed gift by our local community of friends and family. And by "expense" I also mean the time involved in planning and preparing that a meal often takes. It's one less thing we need to worry about during several days of a given week. Often there is more than we can eat in a night and it serves us as leftovers for following nights. THANK YOU as well! It's been delicious!
"The Hair, the Hair . . . " (8/31/11)
By week two of Lisa's first round of Chemo, she started feeling much better but her taste had gone caddywhompus. Still, she's enjoyed the meals delivered to us with a new understanding of texture. Before Chemo, texture was a pleasant adventure, now she enjoys "smooth" foods at an elevated level. As week three rolled around she was nearly back to her old self until the morning, in the shower, when she reached out to me with tears in her eyes and a large, stringy, wet clump of her own hair in her hand.
You can say you're mentally ready for something; jumping out of a perfectly good airplane, off of a cliff with nothing but a rope or hang glider between you and certain death, you moving back in with your parents, one of your parents moving in with you, etc. But when it's your own hair leaving you en masse, that's not an easy one to take. The mass exodus of Lisa's hair shook her. It was nothing less than the physical manifestation of what her body had been going through to date with little more than a slight fever and some taste issues to show for it until the hair thing.
To a woman, hair is something special. Even us latter day baby boomer males know what a "freak flag" means to us. It's a symbol. Symbols can mean many things, freak flags were a symbol of antiestablishmentarianism or a way to get under the skin of our parents. For women, it's about beauty and attraction . . . and self esteem (at least that's my male perspective on it). If you've ever seen Lisa's hair up close and personal, it was breath taking. Naturally curly with natural highlights of auburn, brunette and . . . what I call platinum blonde (gray), it was an envious head of hair to behold.
Seeing the shower scene trauma, I immediately but gently began lobbying for cutting it. That afternoon, we were both sporting shaved heads. I went first (to show her how it's done) and she followed with tears flowing. Tammy at Hair Solutions mentioned how hard it was to cut someone's hair with tears in her eyes. Tammy then gave us access to Operation Uplift's bevvy of hats and wigs so Lisa could pick out something she could sport now that she could no longer "sport" her own hair. It took a few days, but by the end of a couple of days, she was feeling better and feeling better about her hair situation too.
Since then, she's been getting rave reviews about the shape of her head and how beautiful she is. (I could have told them that!) I knew all along. She's since embraced her new look and started wearing earings and even losing (not wearing) the hats. The air is definitely cool on her unprocected, nubile scalp. I've even gone so far as to close/razor shave my scalp. I just didn't wan't her to feel completely isolated.
"DING DING" Round Two (8/31/11)
Yesterday, we went in for round two. I was sure to let our oncologist know what happened last time. I want to be sure to avoid going to the emergency room again. Dr. Nellie mentioned that she was not pleased with the admittance. She thought it could've been handled with an at home regimen of antibiotics. So, with new instructions on when to call in the case of a low grade fever (after repeated temperature readings on two hour intervals) we went in and Lisa got "ported" into the Chemo Zone.
The Chemo Treadmill (10/3/11)
Well, the story to date follows a pattern of sorts:
Lately we've just been on the chemo treadmill. Every three weeks, Lisa goes in to the Thomas Family Cancer Center in Sequim--we actually raised money for this facility in 2007--for treatment on a Tuesday usually in the mid morning or early afternoon. It takes about 3 or 4 hours to get her blood work done, wait for the chemical concoctions to get mixed, get dosed with said chemicals (about an hour for each) and get clearance to leave.
I've been fortunate that my recent project can be done via my laptop so I work on site. The next day Lisa has to get a white blood cell booster shot so I accompany her to that as well. Then she's off work for the rest of the week to avoid infection during the vulnerable period where her white blood cell count dips dramatically. It's been touch and go during this period which usually lasts between a week to a week and a half. However, she goes back to work the next Monday provided she's not running a low grade fever or has any symptoms of infection.
Then, it's just life as usual except we tend not to go anywhere or do much. We are trying to minimize outside contact for fear of contracting a viral or bacterial infection. It's not too bad though. We've recently subscribed to HBO and Netflix and football season has started so we have plenty of TV time. Also, Lisa has a few good books she's been reading lately. Other than that, we've received tons of love from friends and co-workers in the form of meals three times a week. In fact, we're ready to just say thanks but no thanks and get back to our own regarding meal time. Often we get way more than we need and thus don't get to cook much anymore.
In fact, Lisa has since asked not to have anymore meals delivered in October. It's that time of year where we actually enjoy our togetherness in the kitchen cooking up whatever we've discovered from cookbooks, magazine/newspaper articles and/or remember from days gone by. Lisa's mom is currently living with us and often times, she'll get inspired to cook up a meal. Lisa's oldest sister Karen cleans our house for us as well. I feel overcome by the compassion shown by our friends and family and cannot thank them/you all enough.
Lisa's lost about 10-lbs. and gets cold easily. She's only got one more chemo treatment scheduled on the 11th of October. After that, it's radiation treatment five times a week for about 4 - 6 weeks. Luckily the Thomas Family Cancer Center has a state of the art radiation gizmo--one of only two in the US, the other one at Stanford--and it may reduce the treatment cycle down to the minimum of 4 weeks. We'll see. Meanwhile, I for one, look forward to getting back to cooking as a form of relaxation and . . . therapy.
RADIOACTIVE! (12/8/11)
[paraphrased from the 80s tune by the Firm]
RADIOACTIVE! (12/8/11)
[paraphrased from the 80s tune by the Firm]
