It's been a very crabby Christmas.

Things have been pretty quiet around here.  We celebrated Christmas with some friends at the Franciscan on Fisherman's Wharf and ate a ton of crab.  It was the right amount of celebrating for me - something special with friends, but not a lot of effort required on my part. 

I went in yesterday for my pre-op pelvic ultrasound that the gyno surgeon wanted.  She wasn't looking for anything in particular, but wanted to get the lay of the land before going in.  To prep for it I was supposed to drink 32 ounces of water been 2:15 and 2:45 to be ready for a 3:15 appointment.  The idea is that a full bladder makes everything else easier to see. 

I couldn't do it.  I took some zofran ahead of time because I was worried about getting sick, and I got about 26 ounce of water in and just couldn't.  I was too full and could feel the water sloshing around.  I couldn't bend over to take my shoes off and undress to put the gown on and had to ask the nurse to do it for me.  That was embarrassing, but necessary.  So my bladder wasn't as full as they wanted, and she wasn't sure about the quality of picture she got, I might have to go do it again.  If I do, I'll start drinking 90 minutes ahead and pace myself a little more, but I really hope this is good enough. 

The first surgery is now confirmed for January 21 and the second is penciled in for March 3, and they expect to confirm that in the next week or two. 

I'm starting to freak out a little bit about it.  I'm not much of a clotheshorse but my habit is to shop for new t-shirts and gym stuff online after the holidays, and I keep having to stop myself because I have no idea what's going to fit, since I have no idea what size or shape I'm going to be.  Great sale on bras!  Not going to need them for a while or maybe ever.  It's just weird.  I'm not particularly sad about the changes coming, but that could change.  I'm nervous about the surgeries and recovery.  I'm scared of the pain more than anything.  I've had three laproscopic abdominal surgeries in the last decade and I remember what recovering from them was like.  Recovering from the oopherectomy half of the surgery in January will be similar, but add the mastectomies to that and I can't quite comprehend it.  And then the flap surgery will be another level altogether.  People do it and I know I'll be fine, but I'd really just like to go to sleep now and wake up in May with it all done. 

Up until the last couple of weeks (with the major exception of the lung biopsy from hell) I haven't really had to deal with pain at all.  I've been uncomfortable,  and I had some stomach cramps the first couple of weeks on taxol before we got my meds straightened out.  Now I hurt.  Bone pain from the neulasta is pretty close to daily, and the tumor site has started hurting as well.  I'm choosing to believe it's a positive thing as the meds duke it out with with the tumor.  The doctor said it's not anything to worry about.  I'm mostly dealing with it by takine Alleve, but have taken a couple of percocets in the last week when it was bad enough I couldn't sleep. 

In happier news, my hair seems to be back and wanting to stick around.  I've got about a quarter inch of fuzz and my eyebrows came back enough that I had to go them waxed last week.  The individual hairs are still really short, but at least I have a template to color in now.  I felt like a clown for the last few weeks when I tried to put makeup on.  I could still lose it again after the last round of chemo, but it's seeming less and less likely. 

I'm not expecting anything to happen between now and the final chemo on January 3, so things will probably be pretty quiet here.  If I don't get back here before then, I hope you all have a happy new year and we will try to do the same.  :)

Good news today.

We left at 9am this morning and just got home a couple of minutes after 6.  I has been a crazy long day of two giant doctor appointments, and then I missed my window for my neulasta shot so I have to go back out and do it tomorrow.  Not a problem, as long as it happens within 72 hours we're good. 

The radiation oncologist was very nice, and basically said that we won't know for sure until we get the pathology back from the mastectomy, which is exactly what I expected.  Basically if the tumor is over five cm (it's never been bigger than three, with all the ups and downs) OR if there's lymph node involvement I'll need radiation.  She was suggesting radiation before reconstruction, if I need it.  My sister didn't, and I'm hoping to follow her path.  I am worried about the month off between chemo though, if it was going to run wild, that was it's opportunity.   

I realized I can't remember if explained a sentinel node biopsy, so I'll do that here.  When they do a lumpectomy or a mastectomy, before they start cutting they will inject some radioactive and colored dye around the tumor site, then they look for the first lymph nodes to pick it up, and have them biopsied right there while I'm on the table.  If they are clear, then my lymph nodes are predictably good across the board.  If they are cancerous, they start climbing the chain a few nodes to see if it's still contained within the near part of the system.  If they can get to a clean node, we're still good.  If they can't, then I'll need radiation. 

Insert random new side effect here.  I went to the restroom on the way out of the oncologist's office and happened to glance in mirror.  I looked like I had smeared lipstick all over my face and up the right side of my nose almost to my eye.  I wasn't wearing lipstick.  Adriamyacin can do that.  And it did.  Fortunately I had some good makeup in my bag and was able to tone it down a bit, it seems to mostly be gone now and I just look really flushed. 

Anyway, we were there until 11:30 and didn't get out in time to go back to the oncologist's office to get my neulasta shot before the office closes for lunch, So we ended up heading to UCSF.  So we got lunch and were there about an hour early since we were super lucky with parking.  And then we waited, and waited, and waited.  This was the meeting where there was an intern taking notes and going over the questions I had asked ahead of time.  I liked the doc, he's a little cocky but comes highly recommended across the board.  We talked about the other surgeon's concerns about my weight, and the fact that one of them referred me anyway because she thought I'd be a good candidate because of how I carry it.  He did an examination and decided that he thinks I'm good, my skin barely scars and I don't have a history of blood clots.  So, I get the reconstruction I wanted!  YAYYAYYAYYAYYY.  No silicone for me.  No muscles will be moved around, just shifting fat, skin, and blood supplies. 

He also said he'd prefer to do radiation after reconstruction if it's necessary, and said he's got a doc there he'd like me to talk to about it.  

I'm very happy.  I'm looking forward to this heinously painful surgery where they will cut me in half and put me back together. 

So here is the tentative schedule, as of today.  Mastectomy/Oopherectomy penciled in for Janaury 21.  The gyno surgeon's scheduler said her calendar is clear for that day and we just need the surgeon herself to rubber stamp it.  If not the 21st, it will be later that week.

Diep flap reconstruction scheduled for early March, I should have a real date for that by the end of the week. 

For both surgeries I expect to be in the hospital for at least four days to recover. When I get home they said the only personal care I'll need is help with the drains (I'll probably have four for the mastectomy, six for the diep), which means Bob will have to drain the bulbs and measure my output before flushing the contents down the toilet. 

If I do need radiation, we'll start that about six weeks after the diep flap. 

We will definitely be needing lots of help with meal deliveries and maybe some midweek housecleaning/laundry especially with the second surgery.  Bob's out of school until April 1, so he'll be here and able to care for me for the first one.  During the second one (we're hoping) he'll be enrolled in the Electrical Engineering/CS program at Cal State East Bay (about 20 minutes from our house) and taking a full load.  I'll post the actual dates for surgery as soon as I have them. 

I am very happy, and very tired, and on a ton of Zofran and Compazine, so I'm feeling OK, just really tired.  Paul's on his way over with burritos from our favorite taqueria for dinner, and then I expect to be in bed around 9. 

AC Round 3

It's only been a few hours, I haven't puked, but I feel like hell.  Infusion went normally, and I dozed off a bit for the last hour of it.  We came home and planted ourselves on the couch and watched a bunch of fluff on TV (if you must know: Arrow, Continuum, White Collar, BBC Top Gear).  Random trivia about our household - we don't have cable, just a broadband connection and a Mac mini and AppleTV  hooked up to a TV.  Fluff recommendations are welcome, especially if we can get them via Netflix, Hulu, or iTunes! That's pretty much what my brain can handle these days.  We don't watch any "reality" shows because they make my teeth hurt. 

A friend brought us dinner and I was able to eat a Caesar salad, some chicken and a slice of bread after I took a Zofran and let it sit for a while.  Now I'm not so much nauseated, just weird and wrong.  Nothing feels right.  I'm twitchy, I'm tired, my brain starts zipping along at a million miles an hour if I close my eyes for a second (steroids in the IV!).  The bone pain in my pelvis from the Neulasta never really left from the last injection and I get a fresh injection tomorrow.  My legs and knees just feel weak, like I climbed a mountain and forgot to eat to replenish my energy.  The side effects of one or two of the meds I'm on now (honestly, I can't remember which at the moment) include increased risk for ACL and tendon tears in the legs.  So between that, the weak feeling, and the neuropathy in my feet, I'm not doing a whole lot of walking. 

I've now been off the Prednisone for 12 days, and they gave me a low dose of decadron in the infusions mix this time, but we're going to see if I can handle it without adding back the major steroids tomorrow.  Since the mix of side effects for AC is totally different from Taxol, there's not a concern of relapsing with any of the issues I had with that, but I'm keeping an eye out just in case, and the oncologist's number with me.  The steroids directly contribute to the muscle weakness which is why I'm not just taking them.  This is one of those times when I have to balance the side effects with the benefits of a treatment.  

Tomorrow's the marathon day of appointments.  The way I feel now, I fully expect to be sleeping in the car while Bob chauffeurs me all around the bay area (Berkeley, Oakland, San Francisco, Alameda, back home to Oakland).  I'm hoping to have a final decision on the plastic surgery and some educated guesses about radiation by tomorrow night. 

Still no schedule for the mastectomy/oopherectomy.  I called the mastectomy scheduler and she said the oopherectomy scheduler hadn't returned her calls (it's been three weeks now), so I called the oopherectomy scheduler and left a message today.  I'll try harassing from that end for a bit and see if it helps.  It is doubly confusing since the scheduler for each office is named Kim. 

That's it for now.  I'm going to take an Ativan with ginger ale, crawl into bed and hope for the best.  

Long time, no blog.

It has been brought to my attention that I haven't posted anything in a week, and somebody was worried it might be because I've been really sick.  Sorry if anybody got that impression.  I've just been extraordinarily boring. 

It's been pretty constant, low level ick with increasing tiredness.  I'm handling the bone pain from the Neulasta with Alleve and it's been a few days since I needed to take anything for nausea.  Mostly, I'm just tired.  I expect that this is the kind of tired I was supposed to be at the end of the taxol treatment, instead of the half dead that I was.  I'm definitely not healthy, but I'm not a giant bucket of misery either.  I'm reading a bunch, mostly stuff I've read before.  I don't really have the energy for anything new or deep right now. 

I've been trying to stay in since it's been cold and I definitely don't want to be in crowds of people, but I have been out a few times.  Last Wednesday I had dinner with my friends from work - it was the team holiday dinner and they made a point to invite me, which I greatly appreciated and I had a good time. 

Saturday I did my usual breakfast and shopping routine, but was pretty well exhausted by the time I got home at 10:30 in the morning.  I've been doing all the shopping (because I want to), but I'll start handing that off to Bob for the next few weeks.  He's done with finals and football now, and won't be back in school again until April 1, so he's got plenty of free time. 

Tonight we went out to dinner with Paul and saw Frozen.  It's become a habit to do movies on Monday nights because the theaters are relatively empty.  I enjoyed it. 

Tomorrow I've got bloodwork in the morning and then some errands to run.  Wednesday will be round three of AC, and Thursday is going to be crazypants.  We're meeting with the radiation oncologist in the morning to start the conversation about whether or not I'll need radiation.  (I'm really hoping no.)  I expect that the real determination will be based on sentinel node biospies during my mastectomy and maybe another PET scan. 

After that we go back and get my Neulasta shot again.  These things hurt worse than tetanus shots.  I can still feel the ache in my right arm from the first one almost four weeks ago, and I really feel it in my left arm from last time too. 

And then we drive into the city to consult with the final plastic surgeon.  UCSF has this program where they offer an in intern to work with me to develop questions for the doctor and then the intern can sit with us in our consultation and make an audio recording of it.  I said yes, and spent an hour on the phone with Elizabeth this afternoon.  I think we covered everything that's been running around in my head, she's going to type everything up and send it back to me tomorrow, and I can change or add things.  Then she'll pass it to the doctor to read through before he meets me. 

And then we come home and collapse in a heap.  That day would be exhausting if I were perfectly healthy.  Good thing Bob is, and he can do all the driving. 

Mastectomy still isn't scheduled.  I was annoyed when she didn't call back on Friday.  I left another message this morning and didn't hear back (it's been over two weeks now, total) and I'm going to call again first thing tomorrow.  I'm sliding into angry now, and I really don't want to be.  I just want it on the calendar so I can plan the rest of my life around it.

In tumor news, it started shrinking again, finally.  It had basically blown back up to the size it was when I started at Stanford.  Friday it felt really tender and then softened up a bit.  It's still there, but it's definitely smaller again. 

That's all the news from here. 

Weekend Update

This time has definitely been easier.  I'm sleepier faster, and taking a lot more meds, but I know what to expect and how to respond to it now, which is a huge part of the battle. 

Jen was here this weekend and we managed a couple of trips out of the house, followed by long naps for me.  We went out and I spent way too much money on a new recliner for me.  It'll be where I sleep when I'm in recovery and where I sit to work and screw around on the internets for the foreseeable future.  We got this one in a distressed brown leather with a little bit of red in it.  I think it will look nice with our existing furniture and my moroccan rugs. 

We also managed to get me out to breakfast and shopping yesterday, but I was DONE after that, and ended up spending the rest of the day watching too much television and napping. 

This week I have  bunch of phone calls to make but no doctor stuff scheduled, and I plan to stick pretty close to home.  Bob will be here for most of it too - his football season is done now and he's got to study for finals this week. 

AC, Round Two

We had a bit of a late start today.  LabCorp apparently decided they didn't need to actually do the CBC  on the blood sample I left with them yesterday.  So we had to redo that in the office.  Other than that, everything went fine. 

I told the nurse about the pain I had last week on Wednesday and Thursday that I was worried might be my kidneys and she said that it was the neulasta working its magic in my pelvis.  And apparently that's a good thing because it meant all my bloodwork looked really good.  So yay, and this time I know to take some pain meds for it and call it a day. 

There seems to have been a bit of a snafu with getting my appointment set with the DIEP flap guy at UCSF tomorrow (long dumb story, partially my fault for procrastinating about asking the other doc for my records, which aren't there yet).  I'm actually totally fine with that.  Now that I've decided that I'm not going to attempt to have any reconstruction done in the same surgery as the mastectomy, I don't need to make a decision for a while.  I'd like to do it soon, but it doesn't have to be tomorrow.  And Bob couldn't come with me tomorrow because of school, so if we can reschedule for a time when he's on winter break, I'll be perfectly happy. 

Tomorrow is my last day on prednisone and then I'll take the antibiotics for another 48 hours, and then I'm done with the pulmonary nonsense officially.  I've been on daily antibiotics since October 21.  My digestive tract is so borked between that and the chemo.  It's not been that bad because the other major side effect of the anti-nausea meds is constipation.  Mix that with the antibiotic runs and it's not really terrible, but not anything close to normal (for me) either.  I've got a nice big bottle of probiotics that I'll start taking on Sunday morning. 

I need to do one more follow up with them in the next couple of week so they can order the end of oxygen support - it's not costing me anything, but having the equipment here is treated like a prescription, so they need paperwork from the doc saying I'm clear before they come to pick it up.

My energy levels were a bit better than I was expecting the last couple of days, but I'm definitely feeling the infusion tonight, and the anti-nausea stuff makes you sleepy too.  I'm covered from the IV meds from today through tonight at least.  I started feeling it last time in the late afternoon on Thursday, so I'll take a zofran with lunch tomorrow and just keep taking them every 8 hours for the next couple of days, which should get me through the worst of it.  

That's about it for the cancer update.  As I type this, our friend Paul has come over and is helping Bob carry the pieces of the murphy bed that he's been building up from the garage to my office, and now they are trying to put it together and get it installed so Jen can sleep on it tomorrow.  It won't be finished - literally it needs paint and some trim pieces still, but it will be operational, and that is good enough for now. 

My part in this project has been minor, but it has forced me to clean out my office entirely so they can install it.  I've been working on that slowly but surely over the last week or so.  Now my working chair is in the dining room - it's a big futon style armchair and ottoman.  Ugly as sin, but is comfortable and cat proof.  This is where I confess to the world that I hate working at a desk, so I sit in this chair with my feet up, put my laptop on top of an old hospital bed table so it's at the right height for my neck, and type on a keyboard in my lap.  Ergonomically it's just about perfect.    But it's a really ugly set up.  And now it's in the dining room for a few days. 

It's another crazy week of medical stuff!

I need to rewind a bit since I forgot to post on Wednesday, after I saw the gyno surgeon.  She's on board with the remove-everything-in-one-go plan and is going to work on scheduling the surgery this week with Dr. C, and we're aiming to do it in the third or fourth week of January.  She wants me to do a pelvic ultrasound at some point in the next month just so she has a preview of what we're getting into.  Because of the cancer they do this "washing" thing while they're in there, look for other signs of tumors, growths, random weirdness.  I've got weirdness galore because of 20 years of Polcystic Ovarian Syndrome (PCOS).  The pelvic ultrasound isn't painful at all, but is really uncomfortable while they do it, because they make you drink a ton of water and then wait an hour and you need to pee BADLY the entire time, and they're pressing on your abdomen while you're trying not to let go.  It's been a few years since I had one, and the last time I hadn't recently been suffering from stress incontinence.  In the larger scheme of things, this is extremely small potatoes, but I'm not looking forward to it. 

The days are really blurring together for me now, so my holiday weekend was pretty much like any other day except there was excellent turkey and stuffing with friends one night.   Friday we stayed home.  Saturday I was feeling pretty good so I went out for breakfast and grocery shopping.   Last night we had a friend over for dinner and watched the Doctor Who anniversary thing. 

It was nice to have a relatively slow week, because this week is busy again.  This morning I had to go stand in line at the DMV to renew my disabled parking placard.  Tomorrow I have to go do my bloodwork.  Wednesday is infusion day.  Thursday I'm supposed to be going to UCSF to meet with the surgeon that does DIEP flaps (they haven't confirmed yet) and then back to my oncologist for neulasta.  Friday I get to sleep. 

Symptoms have been funny - fairly mild but not what I expected.  I never got the fabled red pee, although it does smell noticeably strange.  The nausea has been coming and going but I only dry heaved once.  I'm now carrying both zofran and compazine with me at all times.  I'll be taking them at regular intervals for the first 72 hours post infusion, and then using them as I need them throughout the week.  This week things that set me off were making cranberry sauce (even though it smelled good), and chinese food we had last night.  It's not bad, it's like that first wave of seasickness so far.  I feel it, I sit down with a ginger ale and take a pill, and its usually gone within 30 minutes or so.  My general appetite seems to be fine, and I no longer have problems with greens (yay salad!).

I'm finding that this whole process is turning me into a hypochondriac.   I now question every random weird feeling in my body.  Last week on Wednesday and Thursday I had something going on in my lower back.  So is it back pain from sitting on my ass all day, every day, for months now with no real exercise?  Or have I done something horrible to my kidneys?  I don't know.  It's fine now.  I'll mention it to the doc on Wednesday when I get my infusion.  The thing is that I can't really tell when I'm being unreasonable - I thought the level of exhaustion I was feeling at the end of the taxol was to be expected, so I didn't complain and wouldn't have gone to the E.R. about it.   So now I'm a little paranoid.  But I'm right to be paranoid.  But I don't really know about which things. 

Something that is amusing me, but also a little annoying - the month off between taxol and AC gave my hair follicles enough time to wake up and grow a little bit.  My scalp looks darker and feels kind of velvety.  (Bob cannot stop petting it, and it's driving me bonkers.)  But it will probably all fall out again starting next week.  In the mean time, My eyebrows and lashes stayed put for most of the taxol run, but then started falling out a couple of weeks ago.  In the last couple of days what was left seems to have spontaneously decided to jump out of my face.  All afternoon for the last several days I've had the sensation of bugs crawling around on my cheeks, and it's more eyebrows gone. 

Boring little update.

Boring is good.  I continued to feel moderately icky through the weekend, but was basically back to what I think of as my current baseline (weak and easily tired out, but not feeling "ill") when I woke up yesterday morning.  Now that I know when the nausea is likely to hit I'll take the meds a few hours earlier in the day next time, which should help prevent it entirely.  

I'm continuing on the sloooow taper of prednisone.  I'm down to 10mg this week, and will drop to 5mg on Friday, and then be entirely off of it by the end of next week.  And then I'll probably start on the decadron again for a day or two after infusions.  

I don't expect that I'll start to feel sick from the chemo again until I have my next infusion a week from tomorrow, so I should be in reasonably good shape for Thanksgiving, which I am thankful for.  (See what I did there?)  We'll be attending a potluck dinner hosted by friends here in Oakland and I'm looking forward to it.  

Tomorrow I've got a checkin with the oncologist to fill her in on how I did this time and then a consult with the gyno surgeon. 

Mentally/psychologically things have loosened up for me a little bit.  For a long time I haven't been able to read the way I would like to, and that's been frustrating.  My mind would just wander, and usually wander into some dark places it didn't really need to go.  I've been spending a ridiculous amount of time playing solitaire games on my phone instead.  It's distracting enough that I don't think about other stuff, but lightweight enough that I can do it and stay occupied when I'm feeling sick or tired. 

It's been nice to get back to reading fiction this week.  I finished the book club book (The Aviary by Kathleen O'Dell) and am reading some other YA stuff for now.  I might dive back into the deeper end of the pool in the next couple of weeks.  

On the projects front I've made small progress - I started to build out a website for the wedding, found somebody to do the flowers, and we think we've found food we like, although the guy hasn't responded to my question about a contract.  But he also seems to just not check email very often.  There's plenty of time to go a different direction if he flakes out in the next couple of weeks.  

On the PMP front, all I have accomplished was finally unpacking all of my books from when we moved 18 months ago.  The PMP books were literally in the very last box.  But now I have all my cookbooks too, and I did a big purge of old tech books that are going straight to recycling and have another box to go to Goodwill.  So actually I suppose that was quite a bit given my current energy levels.

 

Patterns start to emerge.

I slept in again this morning, and was a little hungry.  I ate a fairly sizable breakfast and then was a mix of tired/slightly nauseated/not hungry for most of the day.  I ate a cereal bar around 2, and then started really feeling sick around 5.  Basically the same as yesterday.  I took a zofran and about an hour later was able to eat dinner. 

The hardest thing is really getting in enough liquids.  I'm supposed to be drinking a massive amount of water, but then drinking when I'm not really thirsty makes my stomach uncomfortably full and that triggers the nausea too.  So I'm trying to remember to keep a drink at hand whenever I'm awake and just take a few sips every few minutes.  And I'm having the same problem bending over that I did at JavaOne this year - I discovered that when I attempted to load a couple of things in the dishwasher tonight.   It looks like Bob's going to be stuck with kitchen cleanup for a while. 

I'm feeling the neulasta now too - deep achy feeling in my thighs and pelvis.  I have no idea how long that's supposed to last or if it's going to get worse.  They said I can take alleve or ibuprofen for it, but those both mess my stomach up, so I'm staying away for as long as possible.  

Having said all that, I'm nowhere close to miserable.  Mostly I'm just really tired.  I've got a few good hours a day where I can have a conversation like a normal person or do a puzzle while listening to a podcast.  Then I start spacing out and it's time for another nap. 

So far, so good.

I slept pretty well and slept in a couple hours past my usual time, made my breakfast smoothie (yogurt, egg based protein powder, coconut water, and frozen strawberries today) which went down fine.  I felt good enough to drive myself to the doc for my neulasta shot. 

Apparently Thursdays are old people days at the clinic.  Standing room only in the waiting room and it took about half an hour before Anne had time to give me the shot.  Everyone there had a caregiver, and I'd say at least half of them had some kind of dementia based on the conversations I was hearing.  Maybe they try to do them all at once? It was odd.  Yesterday there was one other guy in the waiting room and we got a private room for my infusion. 

Now I'm home and feeling a little light headed and sleepy.  Not quite nausea, but I can see it from here.  I'm going to try to get  down another 20 ounces of water and something light for lunch and take a nap. 

One AC down, three to go.

I went and did my bloodwork yesterday and that all came back fine so I started the next chemo sequence today.  It is so nice to be doing it ten minutes from home instead of two hours.  Also nice to be able to park right in front of the building instead of waiting ten minutes for a shuttle to take me from the parking structure to the hospital (Stanford is building a new hospital and the parking is totally screwed up). 

I also spent less time there today because I did the blood draw yesterday - at Stanford I would go, do the blood draw, sit for an hour while they got the results back from the lab, and then start the infusion.  This time the labwork was done and I just walked in and they had me plugged in to the machine and starting pre-meds within a few minutes.  We were there just about 2.5 hours and were back home by 4pm. 

I'm still on the prednisone so they didn't give me any other steroids today.  So I started with two different anti-nausea meds (which I've now forgotten the names of, I'll write it down tomorrow when I go back in) which according to the nurse, should be good for a couple of days, and then I'll start to feel barfy sometime Friday or Saturday, at which point I start taking the Zofran I have.  Those took about an hour and then she set up the Cytoxin to go for an hour, and then when that was done she just did a straight push into my port for the Adriamycin, which took about five minutes.  The Adriamycin is a really bright red and turns urine red for a day.  Fun side effect.  And it kicks in fast - I had to pee when I got home and it was already pink, only 30 minutes after she pushed it.  Weird.

I go back tomorrow for a shot of Neulasta which stimulates bone marrow to make more white blood cells to fight infection.

So the regimen I'm on now requires a different set of supplements and followup medications, and a totally different set of side effects and warning signs that something's gone wrong.  If I develop a fever over 100 I have to call the oncologist and head to the emergency room.  The Adriamycin damages the heart, which is why I had to have to ECGs, mostly so we have  baseline after this is over to see what kind of damage is done.  The damage is cumulative based on dose, so there's a lifetime cap on how much you can take, and I think I'm getting the maximum amount over these four infusions.  Other fun things to look for are bowel infections, and painful swelling and redness in the hands and feet, vomiting, and fatigue.  That's just the one drug.

Cytoxin is itself carcinogenic and includes leukemia as one of its side effects.  Are we having fun yet?   Also, hemorrhagic cystitis because it's toxic to the lining of the bladder.  So red pee is good for the first 48 hours, bad any time after that.  I'm supposed to drink at least 80 oz per day for the next 72 hours to clear the stuff out of my system and make sure it doesn't sit too long in my bladder.  It also suppresses the immune system and can cause mouth sores and joint pain, vomiting, and fatigue.

Neulasta causes bone pain, joint pain, vomiting, and fatigue. 

There seems to be a pattern there. 

I'm feeling a little sleepy but otherwise OK now, and I expect to spend a good chunk of the next few days in bed.

In other side effect news, the neuropathy from the taxol seems to be getting a little better in my hands.  I still feel it, but not nearly as much.  My feet are still a mess though, and it's worse when they are cold.  At best it's like walking around with feet that are asleep, and even my softest cashmere socks feel like sandpaper.  At worst, when it's cold, it's like they've turned into bricks.  I can't feel anything at all, and that's pretty scary.  It should get better, but it makes walking really uncomfortable and something that I have to pay full attention to.  Unfamiliar stairs are downright terrifying.  I cannot afford another fall/sprained ankle/broken whatever.  

That's it for now.  I'm off to eat some really bland lasagna from Trader Joe's for dinner and watch something terrible on television before bed. 

Starting chemo again on Wednesday...

..and not a minute too soon - the thing is growing again.

This week of medical crap includes an echocardiogram on Monday, and I'll talk to the cardiologist about the fact that my grandmother was treated for tachycardia for years (I had no idea until a couple of days ago), so it looks like this might just be a coincidence and they found it now because of my hospital stay.

Tuesday I go in for my bloodwork.  Wednesday is chemo.  Thursday I go back for a Neulasta shot to stimulate white blood cells.

Bob's going to go to chemo with me, and Cait's going to babysit me Wednesday night while he goes to a JUG meeting, and then Elise is going to hang out with me on Friday while he works a football game.  

Another loooong day at Stanford.

I'm kind of annoyed.  So far the biopsy from Monday is inconclusive.  Also, when I walked into the pulmonary clinic this morning the doc said he got a call from the lab today to let him know that my influenza finding from the broncosopy was a false positive.  WTF?  Also, the TB test they did was only for active TB, so the inconclusive thing in my lung could still be TB (there are millions of carriers who never convert to active).  My last skin test for it was years ago when I was teaching, and I've done a lot of travel to places where I'd be more likely to pick it up since then (India, Russia, Morocco).  Nobody's asked me to do a skin test yet, and I didn't think to ask for it today either.  I may just do a walk in appointment with my GP and get that done. 

On the plus side, everybody thinks my lungs are doing much better, and I get to step down to 15mg of prednisone tomorrow, then 10 next week, and then 5 after that.  So I guess I can expect to be a smidge more tired again this weekend, although I think that might be balanced out now by the fact that I'm a month out of my last chemo and my lungs are better.  Who knows?  At this point I feel like I need to take every prediction with a grain of salt, even my own. 

After that appointment, I ducked out and went to the office to attend the luncheon with a bunch of executives in our division for the five of us who won the "Marketing Excellence Award" this quarter.  I'm glad I did, there were twelve of us in the room - a mix of the winners and a bunch of the senior executives in marketing. It was actually quite casual and the CMO happened to sit next to me, and we had a nice chat.  Good stuff on the career front, even if I'm not actually working.

After lunch I went back down to Stanford for a pulmonary function test.  The first thing they did was do an arterial blood draw from my wrist - that was a new one for me.  She numbed me up a bit with lidocaine.  It didn't quite kill the pain, but it was tolerable, and then she went into my right wrist with a longer needle than usual to draw blood - the idea being that this was the first stop after my lungs and they would test for blood gasses.

Then she had me do a series of tests where I breathed normally and then inhaled or exhaled faster/slower/more completely into a contraption while wearing a noseclip.  The good news there is that all of my lung functions were completely normal, except (I think) total capacity.  She said that was at 74% of what they would expect, but it could be explained by my weight which could be restricting expansion.  But everything else was perfectly fine, which means I'm safe to exercise and undergo anesthesia and all that good stuff in the future.

I just sent a note off to Dr. W (oncologist at Alta Bates) to let her know and see if she wants to officially greenlight chemo on Wednesday.  I should know tomorrow.  

Nothing else going on until my ECG on Monday.  

Much much much better today.

No pain meds, it's just a slight dull ache now and a little itchy where they did the initial poke in my skin, but I think I'm responding to the dressing not the wound itself.  I don't think I could find the actual puncture mark if there wasn't a giant black X scrawled in sharpie over it on my chest. 

So the biopsy was on Monday.  Yesterday a very stoned Sonya and a very sober Bob went to the second plastic surgery consultant.  She was really great, but she doesn't do the diep flap.  So we talked about what she would recommend for me, and she agreed that she thinks that the diep flap is the best option for me, if we can find someone who will take me as a patient.  She gave me a referral to the expert at UCSF who has done several hundred of these.  The issue is my size - a heavier person is the best candidate for this surgery but not toooooo heavy, and I'm right over the border. 

I asked her what the reasoning is and basically it comes down to blood supply to the tissue, but she thinks the expert guy would take me because I'm very well proportioned for my size, and apparently my skin is in great shape and a scar as minimally as she's ever seen on a patient.  If I carried most of my extra weight on my waist it would never happen. 

The other thing she said was that she doesn't recommend doing the mastectomy and reconstruction in one go.  Lots of people do it, but like the immediate lumpectomy or mastectomy for people who just found the tumor - it actually increases your chances of dying.  But people do it and doctors support it for psychological reasons.  Which I get. 

But can I, personally, live without boobs for a couple of months?  Yes.  And if I can't, this is why Gawd made Xanax.  Seriously. 

So I've got the number for the guy at UCSF and will call him in the morning and see if I can get an appointment.  If he'll do the diep flap, that's the route we'll take. If not, I'll do the lat flap (where they pull the latissmus muscles around from the back to the front) with Doctor Hobson.  It's a plan.  She was really awesome.  She's had breast cancer herself.  I asked her who did her reconstruction and she started laughing and said "who has time for that?"  It's been five years. 


------------------------------------


This morning I went to see Wexler at Alta Bates about starting AC.  She changed things up a bit.  Some new data has come in about doing dense dose being superior, especially in patients like me who advanced really well with taxol.  This means that under the assumption that whatever comes back from the lab about my lung node (tomorrow, I hope) doesn't delay treatment, I'll be starting AC on Wednesday 11/20 at 1pm.  And I'll do it every other Wednesday for four treatments, which puts the last one on New Year's Day.  Which I'm sure they won't do, but I think bumping it back to NYE would actually be an awesome (although very low key) way to end the year.  Because my pulse and blood pressure are still all over the map I have to get a new echocardiogram on Monday. 

Tomorrow I see the pulmonary people at Stanford for what should be the last time unless I need something major done with my lung.  I expect they will tell me to step down to 10 mg of prednisone (I'm on 20 now, down from 40 when we started) for a week or two , and then five for a week or two after that.  And then I can give all the O2 equipment back. 

After I get my lungs checked out I'm stopping off at the office to have lunch with the CMO of the company since I won our equivalent of employee of the month for marketing (-ish - I think there are five winners every quarter)  Anyway, it's an opportunity to get face time with executives who don't know who I am today.  So as long as I'm still feeling good, I'll be there.  And they'll remember the bald lady for sure. 

Friday I have no medical stuff!  It's a miracle.  But I'm having lunch with Mo and we'll start planning out the lotsa helping hands site stuff for real, because now we're getting to where I'm really going to need it. 

The biopsy didn't go as planned, but it went.

The lung nodule biopsy that I wasn't scared of?  Shoulda been scared.  It was yesterday, and it was pretty miserable. 

I was told no food or water after 6am, and to be there at noon to check in and prep for a 1:30 procedure which should take about 30 minutes, and then I would be there for another four hours in recovery because they take two x-rays three hours apart to confirm that my lung wasn't leaking air into my chest cavity/collapsing (pneumothorax).   As part of the procedure consent forms you have to sign a consent for a chest tube and overnight hospitalization in case you get a bad pneumothorax, which does happen in 40% of patients.  Spoiler alert:  I got a pneumothorax (that is really fun to type), which hurts like hell but I did not require a chest tube and did get to come home last night. 

Sooooo.  I got up at 5:15 to give myself enough time to eat breakfast and drink a whole bunch of water.  We left home at 10:45 and checked in right at noon.  One of the CT scanners broke and so of course there was a delay.  They finally brought me in to start my procedure at 2:30.  I was told to expect about 15 minutes of prep and then about 15 minutes with the needle actually in me.

They decided to go in through the front.  I had to be awake for the procedure so I could follow commands as they moved me in and out of the scanner to position the needle correctly.  They rolled me in there, got me on the table, set up the IV but didn't start anything other than saline, and then did an initial scan to locate the mass and choose their entry point.  As that was happening I heard somebody say "oh shit" and a whole lot of commotion, but nobody came into the room for a while.  The nodule was 1cm on the scan from 10/21.  It was 7mm yesterday.  I've had no chemo since 10/21, so yay!  Not a tumor! 

But the doc says that's a really small target and he's not sure it's worth the risk of pneumothorax because he's not confident he can hit it.  So he called Dr. T, the oncologist, and she said she felt it's worth the risk because we need to know what it is before we knock my immune system down again with the AC and the other option is actual surgery.  So he came back in to ask me and I chose to go ahead with it, because doing this wouldn't delay surgery if he couldn't get it, and I want to start AC as soon as possible.  And I was already on the table and ready to go.

They went straight through my right breast at about 2:00 if you're facing me, and about three inches in from my sternum.  They started with lidocaine and the longest needle I've ever seen in my life, and fentanyl and verced in an IV which was supposed to make me sleepy.  HAHAHAHAHAHA.  It did make me sleepy, and then they stabbed me in the chest which woke me right back up, real fast.  I'm pretty sure I did a really good Uma Thurman impression there for a minute.

So then we spent about half an hour with the doc trying to position the needle, and then moving me into the scanner to see if it was close, and then moving me back out of the scanner so he could move the needle a little more, in and out, I have no idea how many times.  And there's this red light thing on the top of the machine and I know the drugs were affecting me even though I was wide awake because I felt like he was feeding me to a Cylon and it was looking me right in the eye.

And then he told me he wanted to stop trying because it was just too small and it was moving every time I breathed and he was very very sorry.  So I asked him if we could try it one last time with me holding my breath, and he humored me, and then seemed really surprised that I had the level of control that I did (thanks pilates!) and then we spent another 45 minutes doing it all again except slower and with me holding my breath in the machine and then trying to hold my breath in the exact same way out of the machine and the lidocaine was wearing off and the Cylon was eating me and he finally got the thing and it hurt so bad I couldn't stop crying.  And I'm crying now, just typing it out.

They clearly were not prepared for the level of pain I was having.  The worst part is that the way I (along with most people) try to calm down and deal with pain is to take deep breaths, and when breathing at all is excruciating that's not possible.   Oh yeah, forgot to mention that they did this in the children's hospital because of that broken CT in the main hospital, so it was a 10 minute ride on the gurney back to recovery through a bunch of public parts of the hospital with me sobbing and Bob following behind carrying my purse and looking as worried as I've ever seen him.  And then another 10 minutes in recovery to get some morphine into my IV.

First chest x-ray, small pneumothorax.  I was still hurting so they gave me vicodin too.  It dulled the pain a bit but didn't even begin to make me sleepy.  Three hour wait.  When they came back to check on me and I had gotten myself back together I asked the doc what the smallest he'd ever done was - and he said "hospital policy is nothing smaller than 8mm".  Oh.

Second x-ray, the pneumothorax was exactly the same size, so they decided to let me go home.  I took another Vicodin and we stopped at Umami Burger because it was 9pm and I was absolutely starving and while it still hurt to breathe deep the pain was under control.  I am convinced of the healing powers of a Royale, poutine style.  (That would be a hamburger patty served on a bed of fries, topped with a short rib, truffle cheese, and gravy.) 

We still have the oxygen equipment here at the house so when we got home I took a percocet and went to bed with the oxygen turned on.  Woke up and took another one at 2am, and another one at 6am, and then I've been OK since.  It's just a dull ache now.

And then I went to the second plastic surgery consult and you'll have to read about that tomorrow because I am tired of typing.  Also, first appointment with oncology at Alta Bates in the morning to talk about when I start chemo again.  

Next week my job is going to see doctors.

Slow progress is still happening.  At this point it's hard to tell what's leftover from my lung issues and what's become difficult from so many months of basically no exercise and the fatigue that follows chemo (they said to expect it to stick around for at least 3 months, and I'm only 3 weeks out now). 

Either way, things are better.  This week has been good, so I dropped down to 20mg of prednisone this morning and will stay on that until I see the lung doc next Thursday, when I expect he'll drop me to 10 and then 5 over the next couple of weeks. 

Next week my calendar is filling up with doctor stuff:

Monday:  Lung biopsy at noon.  They said to expect to be there 4-6 hours including recovery time, and to bring somebody to drive me home because they're going to be giving me fentanyl and verced.  It happens to be Veteran's Day, so Bob doesn't have school.  That worked out well. 

Tuesday:  Consult with the second plastic surgeon. 

Wednesday: See the oncologist at Alta Bates about starting the AC chemo.  Probably schedule another ECG since my pulse has been so wonky and the A part of AC is known to damage the heart.  It's not like I have a choice here, the risk has to be taken or I die of cancer in the next year or two, but at least we'll know the risks and what to look out for. 

Thursday: Check in with the lung doc and a pulmonary function test. 

I should have results back from the lung biopsy by Thursday and expect I'll be starting the next round of chemo during the week of 11/18. 

Checked in with the oncocologist today.

Long evening at the hospital - my appointment was at 4:20 but we didn't actually get seen until 5:30, and weren't done until 7:15.  Bob came with me and we rewarded ourselves with dinner at Umami Burger before heading home. 

Everything is looking good.  I feel like my lungs are almost back to normal, they cleared me to start doing a little bit of exercise, so I'm going to start slow in the morning.  I haven't taken the dog for a walk in three weeks, so I'll take him out in the morning and set a timer when we walk out the door for five minutes, and see how far I get, then turn around and come home.  I'll add time until I'm back up to a 30 minute total walk if I can do it.  Realistically, the next round of chemo may make that goal impossible.  I'm not going to kill myself to do it, but I think getting some kind of regular exercise again will help my body and my head a lot. 

Dr. T. thinks I'm fine to do the biopsy on my lung this week, so we're scheduling it ASAP, and then as soon as that's booked we'll schedule my next batch of chemotherapy for one week after the biopsy.  So I could be starting the AC as soon as next week, which is a huge relief. 

I'm also clear to get my own flu shot this week, so I'll get that done tomorrow or Wednesday.  Once that's done I don't need to be quite so paranoid about being out in public.  I bought a heavier duty fabric version of those paper masks with an exhale valve that makes it comfortable to wear for longer periods of time.  The lung people said I don't need to wear it all the time, but keep it around in case I get into a situation where people are sick around me.  

Both the oncology people and the pulmonary people have said that they really doubt the thing in my lung is cancerous - if it was a a metastasis of my breast cancer it would have shrunk during chemo and it didn't, and it would be extremely rare for someone of my age to have two different cancers at once.  They are concerned that it might be a dormant infection of some kind.  It's definitely not TB, but it could be Valley Fever or some other random thing that I picked up in my travels.  Or it could just be scar tissue from an old infection.  They expect a 72 hour turnaround from both pathology and microbiology once they get a piece of it. 

The biopsy itself doesn't scare me.  They'll put me in a CT machine and go in between my ribs in my back.  The nodule is right up at the top of my right lung so it should be pretty easy to access and they'll do it under a local.  I'll take a valium or two like I do for the MRIs and it should be fine.  The CT isn't nearly as claustrophobic, and this shouldn't take very long. 

I am scared of the AC.  No question there.  It's probably going to be a lot harder on me physically than the taxol was, but I'm also eager to get started.  The tumor doesn't seem to have grown at all in the last couple of weeks and I don't want to give it a chance to start now. 

Tired, but I think that's a good thing.

I stepped down the prednisone (from 40mg to 30mg) yesterday and my breathing still seems fine.  I also dropped the cough suppressant by half yesterday and haven't taken any today, and haven't had a major coughing fit.  All good. 

I also took a real nap for the first time in over a week yesterday, and I'm tired enough to do it today .  I think it's probably a good thing - sleep is an important part of healing and one of the things that bothers me most about all the steroids I've been on is the insomnia.  My body needs to take a break but the drugs won't let it. 

Yesterday I stayed home but stepped up my activity significantly - we did a bunch of long neglected stuff around the house.  Bob did all the heavy lifting, but I went up and down the stairs multiple times yesterday where I'd be really careful to minimize that for the last week. 

Today I went out for breakfast with Cait and then did half the grocery shopping (Trader Joe's and Whole Foods), and I am dead on my feet.  But it's a different kind of exhausted from what I was a couple weeks ago.  I don't know if that makes any sense at all outside my own head, but it feels better.  It's the right kind of tired.  

Lungs are working, so let's take some risks!

I left the house this morning for the first time since I got home from the hospital last Saturday, to drive back to the hospital for a check in with the pulmonary team.  They are really happy with my progress.  I don't need to use the I.S. to expand my lungs any farther.  I took the emergency O2 with me and carried it around, but I felt well enough to walk from the parking structure to the hospital.   There's a bunch of construction, so it's maybe a 6-8 minute walk, which is sadly the most exercise I've had in at least three weeks now.  That went fine, I was a smidge out of breath and tired by the time I got into the clinic, but I think that's just complete lack of activity catching up with me.  We did another O2 test in the hospital where I walked with the monitor on my hand and was breathing well enough to sustain conversation with the doc for about five minutes and never dropped below 92%.  My heart rate is still totally bonkers.  It was 106 when I was sitting there in the office chatting.  It dropped into the 90s while I was walking, and then spiked back up to 120 after I sat back down. 

I finished the Tamiflu yesterday and the original antibiotics this morning.  I still do have a little bit of that dry cough though, which has now been here since the last week of September and was really the first sign of something going wrong.  And that means it's not all right.  It's definitely better, but clearly there's still something happening there. 

So I'm stepping down the prednisone from 40mg a day to 30mg a day, and monitoring myself for any changes tomorrow, and if I continue to be stable or improve, I'll drop down to 20mg a day next Friday.  Of course, prednisone is a major double-edged sword.  It's fixing the inflammation, but reduces my immune response further, so I get to start two weeks of Bactrim tomorrow, to protect me from a fungal infection in my lungs that I'm apparently now at high risk for.  Yay. 

They're scheduling me for a general pulmonary function test sometime next week and then a follow up with them on Nov 14.  

The lung docs feel like I'm safe to do that biopsy, but want to follow the oncologist's lead on it.  I meet with her on Monday afternoon and I think it's likely we'll get the biopsy in late next week if I don't react badly to the prednisone drop over the weekend. 

I utterly failed at not working today, but only because I had a couple of hours worth of final wrap-up phone calls I wanted to do and couldn't get on the schedule yesterday.  I'm really done now.  I do have a couple of things to keep me busy as I feel up for it though, "wedding" planning and I've been trying and never finding the time to do a Project Management Professional certification (PMP) for a couple of years now.  I've got all the books and never had time to study for the test, so I'll spend an hour or two a day on it as I feel up to it over the next few months.  It's not work-work, but it's good to have something to focus on that I can completely set my own pace with. 

Something goes right...

Some good news on the bureaucracy front. As annoyed as I am with my employer for a variety of reasons at the moment, they do seem to do disability right. I filed a claim yesterday for my absence to begin Friday (through April 30, 2014) and they have a company that expedites all that stuff and takes in all the supplemental checks from the state on my behalf, and my paychecks will continue to arrive as usual via direct deposit, and they will be the same size, for the entire time I'm out. With Bob only working half time and being a student right now, this is a huge load off our minds.

So I guess that's it - tomorrow is my last day until next May . WEIRD.

 ---------------------------

Breathing is still improving but has a way to go.  I turned off the oxygen concentrator yesterday because I haven't needed it.  I can climb a flight of stairs without the emergency air, but I'm still a bit out of breath at the top and need to sit for a minute.  That's a lot better than getting dizzy and nearly passing out every third step.  

 I've got two days left on the antibiotics and tamiflu, and then another 10 days or so before we start stepping down the prednisone.  I'm going to keep the emergency air here at the house until I'm off the prednisone entirely, since that seems to be the thing keeping me breathing once the flu is gone.  

In the mean time, I rescheduled my surgery consults that had been on the calendar for yesterday to happen later in the month and I have a follow up with Dr. T at Stanford on Monday to reboot the chemo plan and hopefully schedule a biopsy on the thing in my lung.  

  

Breathing a little easier.

That's literally true. 

Note for those who don't read on FB - if you want to come see me in the next few months you MUST have a current flu vaccination for this season.  I can't take the risk, and I (sadly) can't risk being around kids.  I can trust adults to wash their hands and not sneeze on me (or whatever), but the stakes are too high for me right now to risk kid energy and kid germs.  Note that it takes a full two weeks for you to reach full immunity with the flu shot.  I cannot get one myself until this current issue is resolved.   Even if you don't plan to see me, you should still get a flu shot.  :)   This has been going around the webs today, and I think it's good information for people who are worried about vaccination with all the B.S. that's been going around the web lately - http://www.redwineandapplesauce.com/2013/10/28/setting-the-record-straight-dubunking-all-the-flu-vaccine-myths/

The process of getting oxygen support was interesting - they cleared me to leave the hospital but I couldn't go until a portable tank was delivered to my room.  The way it works is the medical supply company delivered an emergency tank with a four hour supply to my room, and then followed us all the way home (we live about 60 miles from the hospital) to install a big oxygen concentrator machine in our dining room with two 50 foot tubes that basically keep me on a leash around the house.  He also left me with smaller, 7 pound canisters and a backpack to carry one at a time in. 

When we went back out to pick up prescriptions and food on Saturday evening I took one of the emergency tanks with me.  Those work on negative pressure - they only deliver oxygen when I inhale through my nose.  The concentrator delivers a steady stream at steady pressure. 

The way it's worked out is thanks to the weirdly skinny and tall nature of our house, the fifty foot tube is enough to get from the dining room down to the couch, and up into the master bedroom and even into the shower if I need it, so I haven't had to use the rescue tanks or lug them up and down the stairs at all, which is nice. 

I slept with the oxygen on Saturday night, but other than that really haven't needed it except to take the stairs (both up and down).  I spent most of yesterday and today in my office (same floor as the kitchen) and per doctors orders have been getting up once every hour or so to work on my breathing with the incentive thingy-whose-real-name-I-can't-remember, and do 5-10 minutes of "comfortable" activity.  So that's amounted to making a snack or putting my dishes in the dishwasher, starting to organize my pill bottles for the next round of chemo, some small picking up and shuffling of crap around my office.  I'm moving a little faster today and not getting out of breath, but I'll continue to use the concentrator for anything involving the stairs until I can do that without breathing heavily, and I don't intend to leave the house until I'm done with my course of tamiflu and antibiotics, and my fancy new face mask has arrived - I ordered a pack of those generic paper ones they give away at the hospital, and a fancier one with exhalation vents which I hope will be comfortable for public use, so I can do things like go to the movies or the grocery store with more protection for my lungs.  

At that point I'll start venturing out with the mask and the rescue tank and see how I do. 

I'm spending this week really (for real, I promise) doing the stuff I need to do so I can feel comfortable shutting down my work email client on Friday and not opening it again for several months.  This morning coincided with open enrollment starting for benefits for next year.  Tomorrow I'll start the disability stuff.  I've killed most of the meetings on my calendar, but am keeping a few open so I can do an official handoff by phone on to close a few open loops and say goodbye for now to the people I work closely with. 

I expect things to be quiet for the next few days.  I'll start having followup visits to assess when I'm ready to start chemo and get that node biopsied early next week.  Otherwise I've got nothing to do but get better.  

Home

Influenza A finally showed up from the broncoscopy.

Also, I kept quiet about something that could have scared the hell out of a lot of people I spent the weekend with until I was officially cleared.  They flagged me as a possible active TB case on Wednesday night, and I've actually been in an isolation, negative pressure room since Wednesday.  They cleared me at 2pm.  It took another few hours for the oxygen tank to be delivered, and then a while longer at home to get some more O2 support equipment installed at home and pick up my drugs. 

So I'm home, with antibiotics, tamiflu, prednisone, oxygen tanks, and I'm dead tired but pretty happy at this point. 

I expect to not be doing much for the next couple of days, or leaving the house except for medical appointments in the next week. 

hospital, day five

Slept better last night, only a couple of major coughing fits and I stayed plugged in to the O2 so I knew I wouldn't crash.  I've got a bunch of different meds on different schedules and so they never let me sleep more than about 4.5 hours in a row anyway. 

They've ruled out a bunch of stuff from the broncoscopy, but still haven't found a source for the fevers.  I didn't go over 99 today though.  They weighed me this morning and I have dropped 15 pounds since October 15. 

Since I'm officially voluntarily on the O2 I did a little test this morning.  I unplugged myself at 9am and just sat in bed.  at 9:05 I dropped to 89% (which sets the lights blinking and the alarm off on the monitor).  I bounced back up and down for about 10 minutes and then stayed at about 88% on room air for the next 15 minutes.

So, I've been back on the O2 for a good chunk of the day.  The pulmonary people couldn't decide if I was getting worse because I need more meds, or because I've been in bed for five days now (really almost a solid week now - I was minimally active all weekend despite the road trip).   They did decide it's safe for me to start using the incentive breathing thing (you inhale as deep as you can to keep a plastic cup suspended in a tube) so I've been doing that every hour all afternoon.  Trying the no O2 test again now.  So far it's better - holding steady at 96% now with only two drops below 90% in the last 20 minutes.  I will stay on the O2 tonight for sleep.  It seems silly not to if only just to keep the damned alarm from going off even if I'm technically safe. 

Got the breast biopsy back and there is still cancer there, so I will be starting the next 12 weeks of chemo as soon as this breathing thing is resolved and they're able to schedule the biopsy on the thing in my lung.  I hope it's soon for multiple reasons - it would really suck to let the bastard grow up again because I can't handle the treatment right now. 

The great highlight of my day was that they finally let me take a shower.  I haven't done that since Sunday night, and with all the fevers and incontinence, this has been absolutely miserable.  They've done a couple of "bed baths" where they basically wipe you down with warmed up baby wipes.  It helped, but nothing like running water and soap.  I am clean and that alone makes me feel better than I have in days.

The oncology team is ready to let me go tomorrow.  The pulmonary team said maybe Sunday.  

As I've been typing this the low O2 alarm has gone off about five times and the frequency is getting higher.  So I guess I'm back on it then.

hospital, day four

Not much to report.  They put a giant HEPA filter in my room last night, but it dried out the air and made my cough worse, so I went back on the oxygen because they can add a humidifier to it and that helped a bit.  

The bronchoscopy was scheduled for 4pm, and they wouldn't let me eat all day or have any water after 10am.  I haven't been hungry so the food wasn't much of an issue, but being thirsty for several hours was really unpleasant.  I slept most of the day.  And then they didn't actually get me in for the procedure until 5:30. 

I thought they were going to knock me out for it, but they didn't.  I was sedated, but totally aware of what was going on.  They prepped me by having me inhale lidocaine through a nebulizer, and then squirting it directly on the back of my throat, and then swabbing it around the back of my throat with gauze.  It tastes terrible, and my gag reflex wouldn't die (which was the whole point) so that was pretty miserable.  Then they stuck the scope in and poked around for a while.  The monitor was right by my face so I could see the inside of my lungs as he was doing it.

I got back to my room around 8 and ordered dinner.  And that's about it. 

I'm starting to lose track of time in here.  When I called Bob he asked about the biopsy results which were supposed to be back today.  I have no clue. 

Hoping tomorrow will be a day of information on many fronts. 

hospital, day three

Still here.  Had a really really bad night.  I've been having constant, low level nose bleeds since I started chemo, and have basically been blowing giant balls of mucous and blood clots out of my sinuses several times a day for the last few months.  A huge one developed last night and basically blocked me entirely and I woke up gasping for air and with all the monitors and alarms going off and my levels dropped down to the low 60s.  It took about an hour to recover from that, and then I spiked a fever - I normally run at at 97.9, and hadn't popped up higher than 99.2 at any point in this experience (they are taking my temp/blood pressure at least 6 times every 24 hours), and I hit 102.9 at about 10 this morning.

So now I'm here until Friday.  Things did get better this afternoon though.  For the first time since Friday I was able to change position in bed without triggering a massive coughing fit.  Leasha and Bob came by for a while and I was able to talk without coughing a whole bunch, although to be fair I think I'm probably adapting my breathing a little bit to modulate that.  Either way, not coughing as much has been great for two big reasons.  1) not coughing and 2) stress incontinence from the coughing.  I'm really freaking tired of adult diapers and sitting in my own urine all day. 

They sent an occupational therapist to see me today and she was really happy with where I'm at strengthwise.  The biggest deal is making sure I'm able to get up off the toilet and clean myself properly, which is all fine.  It just makes me totally out of breath.  The physical therapist came by as well.  We went for a walk and up and down a flight of stairs.  My oxygen level didn't drop below 90, which is good.  My pulse went up to 139, which ain't.  At rest it's now about 105, which is better than yesterday but still not good.

The lung team came by this afternoon and because of that fever and the stuff that isn't improving, they are going to do a bronchial scope tomorrow.  So they will send this scope down my throat and into my lungs, spray saline in there, look around, get as much of the saline back out as they can, (some sort of vacuum, I guess?) and send that out for testing.

They are also going to be looking at a nodule that they found in my lung during the CT scan yesterday.  Apparently it was there on my PET scan from July 1.  It didn't light up the way my tumor or any of the lymph nodes did, but it's there.  It's not an apples to apples comparison, but it looks like it might be a little bigger now.  Unfortunately it's not in a place where they could snip off a sample while they are in there tomorrow, too high up.  It could be nothing - lots of people have them.  Scar from an old infection, or it could be more cancer.  They'll assess what they can tomorrow and then I'll have to come back in a week or two when the rest of this is resolved and they'll do a CT guided biopsy of it to confirm.  For that, they'll just poke a needle straight into it from my back.  They just don't want to poke a new hole until everything else stabilizes. 

I'm trying hard not to flip out about the possibilities there.  I am less successful than I'd like to be.

hospital, day two

I feel a little better today, but not much.  I got about 8 hours of sleep last night, interrupted a couple of times by nurses doing blood draws and giving me heparin shots (to make sure I don't develop a clot from just sitting in bed for so long).

They took me off the oxygen in my room since I seem to be staying steadily above 95% when I don't do anything.  It's kind of fun to watch the monitor.  It panics when I blow my nose.  The incredible exertion of moving the hospital crap and my phone and laptop from one table to another while still sitting in bed (to make room for my breakfast tray) dropped me down to 89%. 

We did a walking test this afternoon and the results were basically the same as  yesterday - I dropped to 84% (instead of 82%).  That's not much improvement.  One thing did change this afternoon though - my cough was actually productive for the first time.  I've spent most of my time with the bed raised so I'm sitting up and reading the interwebs or my kindle.  I laid it flat this afternoon for a nap and that's when it changed - it got deeper and I started coughing up bubbles. Not mucous.  Just foam and a little bit of tasteless liquid.  The doctors were thrilled (it's a teaching hospital, there are five of them on my case).  I've had a specimen cup waiting for sputum since they checked me in yesterday.  I haven't heard back if they learned anything from it yet. 

So they're still basically treating it like walking pneumonia (the antibiotics) with a side of taxol inflammation (prednisone).  They're also testing for virus, it could be influenza presenting weirdly because of all the drugs I've been taking, and if that's the case they'll start me on tamiflu as well.  
 
I'm planning to lay the bed back flat about an hour before I want to go to sleep and see if that doesn't help move some more of the crap out of there, if it is truly breaking up. 

Across the board they are expecting to see a major improvement tomorrow morning because that will be the third dose of everything, and apparently that's the threshold for most people.  If that happens they will be sending me home with an oxygen tank and monitor tomorrow night.  If not, I'll be here at least another day. 

I didn't get to see Bob today.  He had a long day at school and then an important meeting he didn't want to miss around his football officials association.  He offered to skip it, but I told him to go.  I'm still mostly just in standby mode.  In a random coincidence my sister is in town for a few days with her boyfriend.  He's attending a conference, and she came along for the ride hoping to hang out with me for a bit, so she'll try to come down tomorrow via caltrain or catch a ride with Bob when he comes after class in the morning.  I'm looking forward to that.  Today was good to just be down and by myself.  I'm sure I'll be a bit stir crazy tomorrow now that I've got some active brain cells again. 

This day took a hell of a turn.

I am in the hospital at Stanford with Ground-Glass Opacity of the Lung Parenchyma and some kind of secondary infection to go with it.      Never heard of it?  Me neither.  http://en.wikipedia.org/wiki/Ground_glass_opacity  Apparently it's a rare, late stage response to the Taxol I've been taking for the last 12 weeks, and it basically means that with any exertion at all - like walking 20 yards slowly around the doctors office, my blood oxygen drops below 80%, and also my pulse has been a steady 120 all day.  Good times. Doc says they should have me fixed up with prednisone and antibiotics in about a week, but it's probably going to get worse before it gets better.   

So, to rewind a bit....I've had this cough for about a month now.  Non-productive, annoying.  Slowly getting worse and worse.  Pleurisy, they thought.  And still could have been.  I've been getting more and more fatigued, as expected, from the chemo.  It's cumulative and they say I can expect to be feeling it for about three months after the end of treatment. 

Friday morning I woke up and felt really weird.  I got winded walking from the bed to the bathroom.  I had to pause and catch my breath at least twice when I tried to climb stairs.  There are a lot of stairs in our house.  I take them slow, but never have to stop and pant like that. 

We left for our road trip.  I went into what I'm now calling "standby mode" almost immediately and stayed that way for the entire drive.  Eyes closed, aware of my surroundings, not really asleep, not really awake.  We checked into our hotel.  I had to stop five times to catch my breath just walking down the long corridor to our room.  We went to Jen and Bryan's for dinner and wedding cake tasting, and I was still exhausted - to the point that I crawled into their son's bed (he wasn't home) and slept for a couple of hours.  We went back to the hotel and I slept until 11:30 and I had to get up and shower and check out.  I slept in the car for an hour while we drove to the hotel to meet my family.  I slept for another two hours before feeling OK enough to go to the family reunion.  We were there for about three hours and then went to dinner with my parents and my sister.  I was in bed by 8:30.  We got up and had breakfast with them and then hit the road.  Standby mode for all but about an hour of it.   Went right to bed when I walked in the door.  Standby mode until 7pm when I got up to try to eat something (I've also had zero appetite for days) and cancel the trip to Vegas I was supposed to take tomorrow.  Back to bed at 9:30. 

Up at 6 to drive down to Stanford to do that final mammogram/ultrasound/core biopsy. Bob came down to meet me so he'd be here when we talked to the oncologist.  Bob was expecting her to prescribe an albuterol inhaler or something and call it a day.  

I told her what had been going on over the weekend so she hooked me up to an oxygen monitor and had me do a lap around the exam rooms in the clinic.  My blood oxygen dropped to 82% after I had covered about 20 yards.  Also my heart rate has been about 120 all day, still is.  And then she said "I think we're going to need to admit you to the hospital tonight."

Oh shit. 

Her theory was that I either had a blood clot (that sprained ankle from a few weeks back could have been a cause), or inflammation, or infection in my lungs.  She hooked me up to an oxygen tank, put my ass in a wheelchair, and then I had a CT scan.  And then we did the core biopsy to close out the cancer study which was the whole point of today anyway.   And then we sat around for a few hours while they tried to find a room for me.  And then that room didn't have the right heart monitors so they switched rooms. 

So now I'm in a really nice corner room - private bath, farthest from the nurses station.  It's relatively quiet back here.  I've got an oxygen monitor on my ring finger, a bunch of those contact pads and heart monitor stuck to my chest, and oxygen up my nose.  Still coughing but it seems to have died back a little bit.  The prednisone is trying to keep me up (and succeeding).  I'm also having an epic hot flash from it.   I'm waiting for an ativan to kick in so I can get some sleep. 

None of the docs we talked to tonight were optimistic about me getting out of here tomorrow, and one guy said it could be a full week, depending on how fast I respond to the meds.  If they don't see good response (more oxygen, lower pulse) in the next couple of days they'll go into my lungs and have a look around.  I really really really hope I don't have to go through that. 

In other news, I'll have those biopsy results on Thursday and we'll make the surgery/chemo decision then.  

I know y'all think I'm crazy for doing as much as I've been doing, but I feel weirdly vindicated that this didn't happen as a result of me pushing myself "too hard", it's still just the taxol.  And that makes me even more worried about the AC, which is supposed to be a lot harder on your body.  

Either way, I'm starting the disability paperwork as soon as I have access to my work laptop and expect to take about 6 months off.  I've got a few things I need to wrap up still, but I can do those piecemeal over the next couple of weeks, and then I'm done. 

MRI day

It was pretty uneventful, as these things go. 

Boy have my standards for that sentence changed in the last six months. 

Due to the fact that I need to be stoned out of my gourd to get into that machine and not lose my mind, Bob drove me down to the appointment.  Due to the fact that I am a doofus about scheduling things I had to go to school with him this morning so we could leave straight from there. 

It actually worked out well, my disabled parking permit got us a spot in the faculty lot just outside the library, so I was able to do all my meetings and even a webex on the school wifi from the car, and nobody on the other end noticed. 

We had to get to the imaging center an hour early so I could take my drugs (Zofran, because after the t-shirt experience at JavaOne I was worried about nausea from laying face down for so long, and valium) after signing the consent forms and then wait for them to kick in.  They ran an IV into my hand for the contrast fluid (my port is in EXACTLY the wrong spot to use it for this exercise.)

Getting into the machine was tight, as I new it would be.  Thanks to steroid bloat I'm actually about 5 pounds heavier than I was the last time we did this.  On the happy side, there were a lot more diagnostics to do last time, so I was only in the thing for 30 minutes instead of close to an hour. 

We discussed trying to do a fancier lunch or something for my birthday, but I was just too wrecked and wanted to get home to bed.  We got burgers at Five Guys and came home.  I slept until about 6 and am planning to go back to bed shortly. 

They didn't share any results so I'm in the dark until Monday.  Tomorrow I'm heading in to the office for meetings and then have a whole bunch of distractions lined up for the weekend. 

And, done. With the first part.

I left the house at 6:45 this morning for my 8am appointment for bloodwork and didn't get there until 8:45.  Traffic was unbelievable.  As is the new normal, my port took the flushes just fine, but no blood return, so they set up an IV in my left arm and used that all day for my bloodwork, but still pushed the infusion into the port.  Otherwise everything went as expected.  Long boring day.  Nice nurses.  Actually, one unexpected thing. 

They have a standard routine, even if they know the patient, where any interaction between the patient and nurse that involves medication, bloodwork, or vitals starts with them asking me to confirm my name and birth date, and then they compare that to whatever paperwork or labels they have in hand and the bracelet they place on my wrist at checkin. 

It's a good routine, once I almost accidentally got Theresa somebody's chemo instead of mine, and we caught it because of that system. At some point they noticed this morning that my birthday is tomorrow, and I woke up from my nap to the entire nursing staff singing happy birthday and they presented me with a red velvet cupcake with a hand drawn "candle" (no flames in the infusion rooms).  That was very sweet of them. 

I feel like I've been hit by a truck.  Typically I start my infusions around 4pm for the last few months.  This time we started at 10am, so my head is in a totally different space now than it has been in previous weeks.  And I am right now at the highest toxicity I'll ever have with taxol.  Low level miseries include that stupid pleuritic cough, small but constant nosebleeds from cracked sinuses, low level sore throat, my mouth is dry and tastes like dirty pennies, and the bottom of my left foot is almost entirely numb now.  The neuropathy is starting up in my hands too.  No numbness yet, but I am a lot clutzier than usual - putting things down wrong on tables or knocking things over that I intend to pick up.  They think it'll take a couple of months to get back to normal.  At least it shouldn't get any worse than it is right now. 

Interestingly, my hair never completely fell out.  I still have (significantly smaller) eyebrows and lashes, and about a half inch of white fuzz scattered sparsely across my scalp.  It's well over 99% gone.  I would look like the Crypt Keeper if I had tried to keep the length while it fell out.  Maybe that's preferable to Drew Carey?  Nah.

I can't see it, but I think it's thicker at the nape of my neck.  People like to pet the fuzz.  I'm thinking that I might have it shaved clean next week.  I can do that now because I'll be on a break from chemo at that point and it won't be dangerous if I get a small cut, and it will make wearing hats/scarves/buffs easier and less itchy as it gets colder. 

MRI is scheduled for tomorrow morning.  With the doc's permission I'm delaying taking the next steroid dose until after it's done, so hopefully I can take a bunch of valium and sleep through the claustrophobia.  Bob's driving me, which means I have to get up and go to school with him, and hang out in the library so we can leave as soon as his last class is over. 

Vacation! Banks! The end of the trial is here!

Where were we?  Thursday I took off for the weekend and drove up to Murphys (small town about halfway between San Francisco and Yosemite) to share a vacation house with some friends for the weekend.  I basically did nothing - eat, nap, read, hang out and chat with friends.  Very low key, and very much what I needed to do. 

I came home yesterday afternoon and basically dove straight into paperwork.  I'm trying (and kind of succeeding) to winnow down the big piles of bills that we've been ignoring, and also got started on the paperwork for the short sale on my old condo. 

This morning was more of the same, punctuated by work meetings, getting caught up on email, and my first consultation with a plastic surgeon.  Bob had class this morning, so Cait came with me. 

The doc walked me through the options.  There are basically four kinds of surgery (and a bunch of smaller variations within them). 


The first one, which is the least appealing to me, is the expanders/implants version.  They cut everything off, put a balloon behind the chest wall and over the course of a few weeks add fluid via a port until the balloon has expanded to the size you want.  Then you have surgery and have the expander replaced with an implant.  It's pretty straight forward, but it also pulls a lot of muscles out of place.  Also, implants need to be replaced about every 10 years.  Also, implants are cold, which was a surprise when I first heard it, but it makes sense.  If you've got these bags of saline kind of hanging out in the breeze, they are not going to be the same temperature as the rest of your body. 

Then there are several variations of "flap" surgeries.  These are the ones where you're doing more (or all) of the rebuilding out of body tissue, and the big concern is that whatever you move has to have the right kind of blood supply, or the tissue will die. 

The first kind is pretty standard for women who are reconstructing one breast - they take tissue from the abdomen along with one of the ab muscles and shift the whole thing up - the muscle provides the blood supply and some structure.  Works great for women with one breast to reconstruct, but not for two.  Abs are kind of important for sitting up and stuff.  So that's out. 

The next kind is a bit of a hybrid - they pull your latissimus dorsi muscle and skin (the one that makes ridiculous bodybuilders look like they have wings?) around to the front, and then seal in an implant under it.  Smaller women can do this without implants, but a person of my size would look really out of proportion without some extra bulk under it.  Advantages - no expanders, the surgery is one and done.  But you still need to replace implants every decade or so, and it's not good for people who like to golf (not me) or swim (sometimes me) because that muscle is pretty important for activities like that.  But, for day to day living there are a bunch of other muscles that can be built up with weight training and it wouldn't limit most of the activities I enjoy, although it would change my pilates routine significantly.  Here's some links on it (NSFWish - medical boobs)
http://emedicine.medscape.com/article/1274087-overview and http://www.mayoclinic.com/health/medical/IM00280

The last one is called a DIEP flap.  In this one they pull skin and fat from the abdomen, and pull some of the blood supply from the abdominal muscles without actually cutting them.  This is the most intense of the surgeries, if we do it I'll be on the table for about 15 hours, and I will essentially be getting a tummy tuck in the bargain.  Some links on this one - http://en.wikipedia.org/wiki/DIEP_flap
and https://www.youtube.com/watch?v=tYEt1Pw6FNU

This is the one I want.  It disturbs my musculature the least, requires no implants or expanders, and can be done in one surgery, although it's likely with ANY of these that I'll want to do minor tweaks over time.   I'm a good candidate because I've got quite a bit of extra tissue for them to harvest.  I'm not a perfect candidate because of my scars from the lap band surgeries - those scars mean that some areas might not have enough bloodflow to survive the graft.  But, those scars are pretty small - I've got one 1.5 inch incision that's pretty obvious right at my waistline, and three very very faint ones scattered across my abdomen. 

So the doc took a bunch of pictures of me and is going to consult with his partner who he does all of these surgeries with and decide if they think I'm a good candidate for the DIEP.  If I am, we'll go for it.  If not, I'll do the Lat flap.  If I do the DIEP flap and it fails for some reason, the Lat flap is still a viable option. 

No matter what happens, I'm not going to be the size I am now - the result will be a reduction in size, but I'm very much OK with that, and what's left will be a heckuva lot perkier than what I have now.  I am concerned with overall body shape, but we can tweak my bottom half a bit with lipo (and there's a sentence I never imagined typing) and keep my overall shape the same.  This isn't going to make me thin, by any stretch of the imagination.  I'll still be quite heavy, but I'd like to be heavy and in proportion. 

So now I wait for the doc to consult with his buddy and decide if I'm a good candidate for DIEP.  While I'm waiting, tomorrow will be the last day on the taxol/LCL trial for me.  I have to be at Stanford at 8am for bloodwork, and I expect to be there until the late afternoon doing the wrap up bloodwork.  MRI on Wednesday. 

Week 11

Once again my port was misbehaving.  They don't think it's clotting up, they think there's a kink in the line.  It takes a push just fine, but blood return is so slow that they can't fill the vials for my bloodwork fast enough.  We did three full draws over three hours before we finally got samples (from the back of my hand instead of the port) that prove that I'm not dead yet.  So we started way late, and I got out of there way later.  No meltdown from me this time.  I guess I'm getting better at this. 

I was weirdly sad to leave.  The first and last days of the trial happen in a different building, so while this was my 11th infusion, it was my 10th and last at this facility.  They really go over the top to make you feel welcome - the front desk staff makes a point of knowing the schedule before you get there, and always greeting you by name if they can confidently do it when they call you from the line (if there's a line at all).  They only messed up once on me, when I showed up an hour early for something.  And the next week the woman who did it happened to be in the parking lot before my appointment and called my name to let me know she remembered.  It's a lot of little stuff, but it counts. 

Today I made all the phone calls.  Got my MRI booked for next Wednesday.  Got two different plastic surgery consults booked and the gyno surgeon.  Also did a bunch of bank stuff, because what you really need on top of cancer and a slightly sprained ankle and a full time job is bullshit like this. 

Wells Fargo is attempting to foreclose on the house we just bought even though we've paid every bill on time since we moved in.  They just helpfully decided to apply one of our mortgage payments to principal and set off a spiral of "late fees" and "missed payments" that were never applied to the account because they don't "accept partial payments".  I think it's all straightened out now.  If I were healthier (and/or this continues unresolved for another couple of weeks) I would start a social media shitstorm about it (social marketing is basically what I do for a living now, I'm pretty good at it), but I just can't apply any more energy to it right now.  And they've got another 29 theoretical years to try to screw us over again.  I'll be keeping a closer eye out. 

The condo I've been waiting for someone to foreclose on for the past 16 months as it's been sitting and unpaid for finally had some movement.  Collections called me.  I started the process to do a deed in lieu, but also called our real estate agent (who I've worked with multiple times now and love dearly) to ask for advice.  She said she thinks she can get a short sale done for me, with no more effort on my part than filling out a couple of forms and she'll do the rest of the legwork.  So I agreed to it.  It's better for my credit rating, which would allow us to refi away from Wells Fargo (and our PMI) on this place sooner.  It's a really nice studio, right on the beach and a giant park with gorgeous walking/bike paths.  I loved that place for a long long time, it just wasn't big enough for me and Bob to both live and work from home.  BofA refused a short sale the first time I asked because I "make too much money" and had no other hardships.  Well now I have a bigger mortgage and cancer, so I've got no trouble with the hardship qualification.  We'll see how it goes. 

The oncologist confirmed the neuropathy in my feet.  Apparently I've done everything really really right with my supplements and meds and eating strategy - like the anemia and pleurisy, they expected to see those symptoms in week 6, which is when everybody else gets them.  She thinks I staved it off enough with the glutamine supplements that I should get the feeling back in my feet within about a month of finishing treatment.  But then it's also a side effect of the AC chemo, so I might get it back just in time to start over again. 

Tomorrow I get up early to run one meeting at 7am, then I'll spend an hour on that paperwork for the short sale, and then I'm off on vacation.  I'm excited, but a little worried that with all this free time I'll have time to think.  About stuff.  I'm bringing the laptop that doesn't have the security crap for work on it so that temptation won't be there, and a Kindle stocked with a lot of trashy novels, and comfy pants for days.  Everybody else is going spelunking.  Hahahahahahaha.