Excuse me ma'am

I worked out last night. It was the first time in a while and I'm feeling it. I came home and told my husband about my work out and my encounter with a young woman at the club. Today he wrote about it. Just when I think he can't possibly understand what's going on in my head, he proves me wrong. Here's what he wrote:


Excuse Me, Ma'am

by Chuck Stromme

“Not bad for an old lady” she thinks, smiling, toweling off the sweat. It's hot in her exercise club.

It's been a hard year. After a good start – a two week trip overseas, a lovely early spring, a flowering garden – she had found that lump. That damn lump. Spring flowers gave way to a lumpectomy, gardening to chemo, harvest to radiation. Now it's winter again.

She's always been secretly proud of her breasts and her once copper-penny red hair. I mean really, who wouldn't be? Her breast is, well, different now. Her hair fell out. Again. There are new scars. Getting old sucks, she thinks. Well, OK, the hair is coming back at least but the rest of growing old still sucks.

But today, today is one of the good days. She's working out with her buff and younger masseuse friend. Even keeping up a little, sort of. Stretch this, lift that, faster pace, smile through the muscle strain. That kind of good day. She's wearing one of her breast cancer shirts.

“Excuse me, please.” Who... oh, a kid needs to get by. “Oh, sure, no problem.”

A moment later “Excuse me, ma'am.” She looks, sees for the first time. A very small, severely handicapped, twenty-something young woman is shyly trying to get her attention. The woman, not much more than a girl really, has one of those pink tied-ribbon shirts on. She says, in not much more than a whisper, “I had breast cancer, too.” Then, “I lost my breast.”

Life, of course, isn't fair. For each of us who is fortunate, there are those less fortunate. For each of us who are multiply blessed, others are multiply afflicted. We don't see the others very often, mostly because we don't choose to, but sometimes we encounter their reality. Sometimes we have no choice. Sometimes it taps us and says “Excuse me, ma'am.”

No one is ready for that kind of reality. We're not ready for harsh or cruel. We forget they exist while we're basking in good and fulfilled. We don't know what to do when we meet the others.

Only one response will get you through a time like this. Take in the reality. Embrace it and let it affect you. Know it and make it a part of you and only then can you grow from the experience. Don't shun the afflicted. They've had too much of that. Smile, engage them, touch them if it's appropriate. You can acknowledge that you're both fruit of the same tree, then each can go on her way without pity or envy.

Merry Christmas.

CAST ADRIFT

Since my treatment ended in October, I have felt cast adrift. I haven't blogged because I have had nothing to say that didn’t seem pessimistic or worse. Even the recent articles about recommended later and fewer mammograms didn’t anger me enough to respond.

What has angered me is the added recommendation that doctors stop teaching women how to do self exams on their breasts. Really?! What could be more benign than that? At first I thought it was a mistake; but no, it’s part of the recommendation. The underlying purpose is simple. If women examine themselves, they will find lumps. Most of these lumps are made up of benign tissue--lumpy breasts, fibrous breasts or just plain random deposits of tissue that is different from the surrounding tissue. All of these can lead to tests and procedures and, of course, anxiety. The tests can be expensive and the anxiety is “bad” for women. Therefore, it would be better if all these false alarms could be avoided. Of course that would also mean that early detection would be avoided as well.

The question then becomes, does early detection really make a difference? A recent article in the Fall, 2009, issue of Cure Magazine questions the value of routine screenings. The article compared cancer to an asteroid hurtling toward earth. If the asteroid can’t be stopped, does it really help to know three months or three years in advance that it is on the way? The end result is the same. On the other hand, if there is a way to destroy the asteroid before it arrives, the earlier it is detected the better. The point of the article is that all too often detection and treatment does not add significant time to the patient’s life expectancy and frequently reduces the quality of the time remaining. Findings indicate that this is particularly true for prostate cancer. Men can live for a number of years with this slow gowing cancer while the treatment can significatly impair their general health. This may be the case with other types of cancer as well.

However, the fact that it might rarely make a difference in the final outcome doesn’t matter to those “exceptions” who are still alive years after diagnosis and treatment. Most of them are convinced that they would be dead if they had not discovered and treated their cancers.

I am certainly convinced that my bout with uterine cancer in 1996 would have killed me if I had not had surgery, chemo and radiation. How can we ever be sure though? If this Triple Negative breast cancer is going to ultimately be the death of me and my treatment was all for nothing, maybe I would prefer to have the six months back and go on a cruise instead. How can we dare to make such choices and leave our loved ones wondering if we abandoned them without putting up a fight? For me, that's the toughest question of all.

.

Fuzzy Wuzzy

Fuzzy Wuzzy Was A Bear

Fuzzy Wuzzy Had No Hair

Fussy Wuzzy Wasn’t Fuzzy Wuzzy?


That’s me… Fuzzy Wuzzy.

All my too short hair is standing straight up. No curl yet, but maybe there isn’t enough of it to show any curl. I’m hoping for the soft “chemo perm” I got last time but who knows what makes the hair curl or change color. It just does. I guess I should just be grateful not to have hair at all. That is at least a possibility. I have talked to post chemo women who had little or no hair return for a long time. So I’ll rub my fuzz and try to be patient.

By the way, the cute guy with me is grandson Douglas. We love to do puzzles together

.

And None to Go

Tuesday was my last day of radiation treatment. Now there is nothing left to do but heal and wait. The fatigue lingers but I am hoping the pain won’t. On the outside, it looks like the worst sunburn ever; a hot, tender bright red with blisters. It’s already starting to peel around the edges. On the inside it reminds me of shingles. Jittery pain messages zip around, careening into each other and reminding me that the worst of the burn is deep inside. I just hope that the nerves don’t take as long to heal as they do with “real” shingles. Dr. Wendland, my radiation doc. advised me that the nerve pain could last from a few weeks to several months. I’m hoping for the few weeks…

My radiation therapists and Dr. W. all gave me congratulatory hugs which made me feel emotional and a little sad. I think the sadness was a mixture of relief and anxiety. It feels strange to be cut loose from the demands of treatment. It feels like I am no longer actively fighting the cancer. I try not to obsess about it but I know from my past experience that it will take a while to get myself to where it doesn’t dominate my thinking. I know the time will come will I can go longer and longer without thinking about it. Eventually, I will only get anxious just before a check up. A long way down the road I may even forget to schedule my check up. (Like I forgot to schedule my annual mammogram) Or, maybe having learned that lesson, I will be careful to schedule and monitor important check ups and take better care of myself.

Recurrence anxiety has at least one positive aspect and that is that it lends urgency to daily life and an appreciation for everyday pleasures. I hope not to lose that but I know it is easy to sink into complacency. I need to find a place in between where I can keep the fear at bay and still relish being alive.

.

Bucket List - First Draft

Anything that requires strength or endurance is pretty much out of the question, at least for the near future. That doesn’t leave a lot. Clearly bucket lists should be started at a much earlier point in life. So if parasailing, scuba diving and zip line adventures are out of the question, what’s left?

I can’t help thinking about some of the things I regret not doing. I wish I had spent more time with kids and grandkids while I was healthier. I wish I had met my brother, Steve. I wish my husband and I were better travel companions. I wish I had gone to Italy and the British Isles. I wish I had seen Stonehenge. I wish I had visited out local community theatre. It seems a waste of time to focus on wishes and "might have been" things. A bucket list should be for things that are still possible. So, what is still possible? Here goes my first draft Bucket List in no particular order.

1) Watch my grandson, Douglas, play basketball

2) Meet my brother Steve who lives in South Carolina

3) Visit the Butchart Gardens in Victoria, Canada

4) Visit the Oregon Gardens

5) Camp at Silver Falls with the Siekman clan

6) Visit Rob and Kathy in Sierra Vista, Arizona

7) Watch the whales and dolphins from the beach at Kauai

8) Snorkel in warm tropical water

9) Take an Alaska cruise, see Denali, visit our friend Bob

10) Go to Carmel with my friend Ruth

11) Spend time at the ocean

12) Have a pumpkin carving day with granddaughter Lucy

13) Reunion with my California sibs

14) Laugh, talk and play with friends

15) Go to the beach every chance I get

Wow! Fifteen things. I thought I’d be lucky to come up with ten. Guess I’m more ambitious than I thought.

Last week end, my friend Kizzie and I went to Yachats and stayed one night at the Overleaf Hotel and resort. We walked on the beach and watched the surf and the sunset. Watching the water and hearing the soothing sounds of the ocean are calming and therapeutic for me. It was a blessing to have a brief “ocean fix” but it always ends too soon for me so going to the beach stays on the list.

The reunion with my California sibs is already scheduled for November so I am already putting the list to work.

.

Single Digits

Seven. It’s a great number. I was born in the seventh month of the year. There are seven days in the weeks, seven wonders in the world and, of course, the lucky jackpot—777. Now I have seven days of radiation left.

On Friday, when I had eight days left, they started my “booster” radiation. The booster is a bonus of extra intense doses targeted at the tumor cavity. This is based on the theory that if there are any stray cancer cells they are most likely to be here at the original site of my cancer. One might think that if those cells had any gumption or energy at all they would have moved on in the five months since my surgery.

It seems to me things could have been done differently. Of course I don’t recall anyone asking me what order I thought things should take. It makes sense to me that treatment would move from the most specific area to the full body approach. That would mean surgery, targeted radiation, wider area radiation and then chemo therapy. I guess it’s a little late to bring this up now.

So, seven treatments to go. Then I can start working on my Bucket List.


.

Left Behind?

I just read about a minister who got his feelings hurt because he wasn’t invited to a picnic given by a group from his congregation. When someone realized the oversight and called to invite him, he told the caller it was too late. He had already prayed for rain.

Why does that resonate with me? I guess I’m still thinking about the “envy thing”. My life feels stalled and passive while everyone else is moving on with such purpose and bustle that I feel left behind. I imagine and hope that will all change when my treatment is over and my strength returns. Then I can begin planning trips and outings with confidence that I will be able to not just endure but enjoy the activity.

A quick glance at the paper shows dozens of things that I think I would normally enjoy doing but don’t have the energy to pursue. Realistically, however, I confess that it has been a long time since I went to a concert or a play. My inertia must have preceded my treatment with me scarcely realizing it. When did it happen that the major events of my weeks and months were church and brief get togethers with friends to visit or have lunch?

That really isn’t true, is it? I was in Georgia just this January and February visiting our orphanage and spending time with friends. Surely that isn’t boring and does require some level of energy. During my treatment and recovery I have enjoyed visiting with friends and relished normal activities. I’ve laughed and giggled and shared old memories and made new ones. Maybe it’s all in my head that my life has become a long, lazy period with breaks for appointments and treatments and little else.

I haven’t been left behind after all. I’m just stalled a bit. My canoe is tied up at the shore for a while but friends row by and bring me flowers and sweets and shower me with encouragement and love. The river is waiting when I’m ready to row again.

.

Two Down, One to Go

If I divide my treatment into parts, it seems like I am at least two thirds of the way through: Part 1) Diagnosis and surgery; Part 2) Chemotherapy; Part 3) Radiation. It’s the old familiar cut, poison and burn. Still, I think there is a fourth part. I call it “The Waiting”.

After all the treatments are over, an abyss opens. No appointments, no treatments, I’m no longer actively fighting the cancer. It feels like surrender somehow. It’s time to wait and see if the battle was won or lost. Will there be another battle? Did we get it all? What’s going on in there that I can’t feel and don’t know about?

Dr. Cho says we’ll do some blood work every three months but mostly we will wait to see if I am symptomatic. What does that mean? Well, since breast cancer typically spreads to bone, lung or brain, we will wait for bone pain, headaches or respiratory symptoms. I wonder how I will know the difference between these pains and my ordinary aches and pains and headaches. “They’ll be worse.” Dr. Cho answers.

During my previous experience with cancer, I remember the high anxiety before each follow-up CT Scan. Gradually, it got easier and I finally came to believe the cancer was gone. Really, truly gone. That is, I believed it until this new cancer showed up. I know they are not related. Not directly anyway. But it does make me wonder if I have poor defenses against those wayward cancer cells that all of us have floating around in our systems. Is it my diet? Would this have happened if I had eaten better or exercised more faithfully or is it just happenstance?

I know there are people who do everything “right” and still get cancer and, of course, we see the reverse of that: people who do absolutely everything wrong and live long enough to wish they had taken better care of their bodies. I’ve already experienced that regret. Certainly I could have/should have done more to keep my arms toned instead of flabby, and to firm my midriff. I seem to have misplaced my waist altogether.

I suppose a certain amount of decay and decline is inevitable but I do see plenty of women my age or older still active and able to make their bodies obey their commands. They dance, hike, bike, run, compete and seem at home in their bodies. They travel the world, take cruises, see the sights from high places that they manage to climb with nary a complaint from hips, knees and feet. Is it just luck of the draw? Did they get issued better equipment at the starting gate? Or do they have invisible burdens, unknown ailments and painful memories?

I’m ashamed of my envy. I don’t want less for them. I want to celebrate their accomplishments and enjoy their activities even if it is only vicariously. I want to make plans for myself and to believe I will be able to live normally again. I want my life to stop getting smaller.

Perhaps it is silly to think there is some sort of cosmic balance or fairness to our existence. One need only open a paper or turn on the television to witness the truth that the world is full of extraordinary unfairness and injustice. That makes me think that it’s much more important to focus on our good fortune than on the things we wish we had. Why is that so hard to do?

.

Side Bar

It’s been a long time since I’ve posted to my blog. That is partly because I have been tired and caught up in treatment and treating the effects of treatment and partly because I couldn’t get past my own dark thoughts to write in what I consider my “true voice” which is one of hope and optimism. It now occurs to me that there is little use writing a blog to share my feelings if I edit out all the unacceptable feelings. I’ll try to keep Little Miss Sunshine in check but she’s pretty deeply embedded so I will have to resist her editing.

Hitting the Wall

This has nothing at all to do with Pink Floyd for those of you who remember his wall.

We have long used the term “hitting the wall” for saying, “I’m out of energy and done for the day”. Going through cancer treatment has redefined the wall. It is more impenetrable than before--a solid resistance to any activity whatsoever. What once was more like an encounter with a giant Sponge Bob it now more like a true wall, not a suggestion of a wall but very real rock and mortar WALL.

My daughter who suffers a long term chronic illness insists on wrestling with her wall. Getting the coffee pot set up the night before, putting those last few evening dishes in the dishwasher, doing those last few housekeeping chores that she doesn’t want to wake up to in the morning, just one more thing before she can let herself fall into bed. Sometimes she completes her tasks barely conscious or coherent. But for her it means she has won a small victory over the wall. The thing is, the wall doesn’t to like to be defeated. If will come around and get you some other way if you don’t respect it.

It’s a bitter pill to swallow when routines that were easily accomplished just months ago are now too much to do. I can’t help wonder how I got so much weaker and whether or not my strength will come back again. It’s one thing to accept that I can’t do what I could at 35, 45 or even 55, but what about just a few months ago. My routine activities from my previous life now seem like a hectic, busy whirl of action, movement and involvement.

I know things will change when my treatment is done. My strength will return and then I will get to decide how much of my past activity and commitments I can comfortably resume. I will do what my brave friend LaVae has done—reinvent my life. I am convinced that this is something we should do periodically and it shouldn’t take a life threatening illness or a major upheaval in our lives to persuade us to do it.

Things change—we change. The wall is just a reminder that what you can’t get through you may have to go around or outsmart. This is when you have to call up all your resources. Yes, the internet helps, but your best resource is your friends. You may not know why you picked such an interesting variety of friends but it is because one of them will have the answer to almost every problem you face. Time to cal them up, invite them over, send them an e-mail. And, zap, just like that an answer comes back that will put you on the right track.

If you don’t already have a circle of amazing smart friends, get started creating one. They will become more important than doctors or advice books in getting you through anything that turns your life upside down. Never underestimate the power of the wall to thwart you but NEVER ever underestimate the power of friends to get you over under around or through that wall.

.

FOUR DOWN - NONE TO GO!

I had my last chemo treatment yesterday and would be doing cart wheels if I wasn’t so tired. They couldn't get the right vein to get the IV in but finally found one that sort of worked. Then they had to move to another one for the Adriomycin because it's so toxic. We were there almost five hours. I was able to doze in and out part of the time. Our friend Tami took me to the treatment because Chuck was too sick to drive. He is still recovering from a bout with food poisoning over the weekend. Tami got me back home and I crashed on the couch for a while and then went to bed. This is my last chemo thank goodness and now all I have to do is rest and get my energy back for a while. I go in August 18th to get "mapped" for my radiation. My body just wants to sleep and I guess that is a good thing. I will try to rest and relax and make the most of the time I have before beginning the next phase of treatment which will involve driving to town and back every week day for six and a half weeks. SIGH…

Limited Benefits of Cancer Screening

There was an article in the New York Times today with this headline: In Push for Cancer Screening, Limited Benefits. Why they didn’t say, “Limited Benefits in Push for Cancer Screening” is a topic for another time.

The thrust of the article is that the benefits of various screening tests including mammograms, PSA tests, colonoscopies, etc. is questionable. The cost of mammograms alone is an estimated $4 billion dollars a year. Following are excerpts of key points. For the full article, go to the New York Times website.

“According to Dr. David H. Newman, author of the book “Hippocrates’ Shadow: Secrets from the House of Medicine.” Some of those tests cause false alarms that lead to unnecessary follow-up surgery on normal breasts, at a cost of $14 billion to $70 billion over a decade, according to Dr. Newman, the director of clinical research in the department of emergency medicine at St. Luke’s Roosevelt Hospital Center in Manhattan.

Cancer awareness campaigns can be a disservice to the public by making people overestimate their risk of dying from cancer, according to Dr. Steven Woloshin, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice. Thyroid cancer, for example, is a rare disease that kills an estimated 1,600 Americans a year. But the campaign called “Check Your Neck” makes it seem as if everyone should worry about the disease, Dr. Woloshin said. But there is no evidence that routine neck exams reduce the risk of dying from thyroid cancer, said Dr. Barnett S. Kramer, the associate director for disease prevention at the National Institutes of Health, which has a cancer Web site describing the potential benefits and risks of many cancer screening tests. Most thyroid cancers are so slow-growing and curable that early detection would not improve their prognosis, he said, while a rarer form of thyroid cancer is so aggressive that a surge in screening would be unlikely to have an impact on the death rate.

Dr. Ned Calonge, the chairman of the United States Preventive Services Task Force said, “There are five things that can happen as a result of screening tests, and four of them are bad.” His group consists of independent medical experts that Congress has commissioned to make recommendations, based on medical evidence, about what preventive measures actually work.

The one good result of screening, Dr. Calonge said, is identifying a life-threatening form of cancer that actually responds to timely intervention. The possible bad outcomes, he said, are results that falsely indicate cancer and cause needless anxiety and unnecessary procedures that can lead to complications; that fail to diagnose an existing cancer, which could lull a patient into ignoring real symptoms as the cancer progresses; that detect slow-growing or stable cancers that are not life-threatening and would not otherwise have required treatment; and that detect aggressive life-threatening cancers whose outcome is not changed by early detection.

Experts like Dr. Calonge say screening is useful only if, on balance, the deaths prevented by treating cancers outweigh the harm done by treatments that are not medically necessary. The problem is, most current screening tests are not sophisticated enough to determine which cancers might not require treatment — or to predict which life-threatening cancers will respond to treatment.

There are a fairly large number of comments after the article. They mainly fall into two categories. The first group takes a pragmatic approach supporting the idea of less screening to save money. The second group consists of people who were saved by early detection or lost family members due to lack of early detection. They personalize the issue and think that awareness and early detection are valuable tools in the fight against cancer.

On a personal level, I have to wonder how I would have felt if, after discovering my lump, I had been told that it would be wise to “track” it for six months before deciding on a course of action. I would have to say that I fall into the category of people who think I would rather be “doing something” than taking a “wait and see attitude”.

We could really save a lot of money if we only tested people during their “productive” years and maybe backed off testing and treatment after a certain age. Oh, say, 69 or even 79. If we are objectively talking about how to dispense limited medical care that might make sense in the abstract, but what if you or your mother are sister fall into the “don’t bother” category?

Personally, I would much prefer being given a reasonable interpretation of the odds of treatment vs. no treatment and make the choice for myself. One part of the article indicates that people might be happier in general if they didn’t know until it was too late to do anything because they would save themselves anxiety and stress. Ignorance is bliss? I don’t think so.

.

Where's My Focus?

I flip through magazines and books trying to get insights and information but end up not remembering what I’ve read. I try to watch a tv show, but the plot makes no sense to me. Books that I would usually devour and enjoy don’t capture my interest. Organizing a box of stuff or a room seems beyond my ability. Where did my focus go? Will it come back?

Our “Big” tv broke down and the bulb Chuck replaced fixed it for a day before it broke again. We scarcely finished the “Fixed It” dance before it wasn’t fixed again. Now it’s in the shop. It may or may not be fixable. I can relate to that.

The refrigerator decided ten years is long enough for it to chug along so it proceeded to defrost itself permanently. Chuck read up on the internet about the problems that seem to be pretty common in our ever so reliable Maytag. Turns out they are not so reliable after all. I can relate. He did all the suggested things and now there is one more part that might fix it. If not, we will be shopping for a new refrigerator. Didn’t refrigerators used to last much longer than ten years? Yeah, I thought so too.

Repair or replace. It’s frustrating but a fairly simple process. I wish my repairs were as easy. Where do we get the part that makes my focus work right again?

.

Kindness Has Many Faces

I was going to title this “How to Ask For What You Need” but I thought that might imply that I have some answer to the question. Unfortunately, I don’t have the answer. I threw the question out to some friends and didn’t get much response. Perhaps I’m not the only one who has trouble asking for what I want.

Kindness has so many faces. It’s such a wonderful blessing when someone simply intuits a need and fills it. Like when my friend Tami says “I’m coming over to work in the yard for a couple of hours. Just tell me where to start.” Or my friend Dale says, “I’m bringing dinner. Is there anything you can’t eat?” It’s a wonderful thing when my friend Brence asks “Where’s your favorite lotion? You need a foot rub.” Or Vera says, “How about a little cribbage? I’ll bring dinner.” Things like that can almost bring me to tears.

My high school friend Ruth visited recently just to “BE” with me. She is very good at that. She helps me feel less tethered to be present and worried about the future. We lost ourselves in an afternoon of just being. It’s a rare gift.

My friend Kizzie gave me another version of “being”. When I got my first cancer diagnosis in 1996, she was the chaplain at the hospital where I had my surgery. She appeared in my room and said, “I hear you had some bad news. May I sit with you?” She sat by my bed and held my hand and let me cry. She didn’t offer a single platitude or quote scripture. She just sat until my husband returned and took over. The fact that I still remember her precise words, says exactly how much they meant to me that day.

Of course those are all the ones who know what to do. It’s harder when someone says, “Let me know if there’s anything you need.” I’m beginning to think I should have a check list ready and offer people an assignment but usually I’m too caught by surprise to actually suggest anything. I’ve decided that if I’m ever in the position of having a number of people offer help I should have a sign up list that includes their name, phone number and skills. This might seem crass but it’s definitely practical. Or maybe I should “just happen” to have a list available to pull out of my purse like a rabbit out of a hat.

I do think people really mean it when they offer, they just don’t know what to suggest and neither do I. There’s got to be a better way.

It gets even harder when the person I need something from is close to me. I want them to just know what I need and when I need it but that’s unrealistic. People can’t read minds and get frustrated trying.

When my husband asks what I need, I usually end up giving some vague answer that includes things like warmth, affection, patience and kindness. These are wonderful attributes, but they aren’t specific things that I would like him to do: like make me a baked sweet potato, cuddle me on the couch, rub out the kinks in my shoulders. Why are those things so much harder to ask for? I think the reason they are harder is because I am afraid my request might not be honored. Then I will feel rejected or frustrated. Sometimes, I think I’m not worthy enough to ask for such frivolous things. I’m not sure which is stronger: my fear of rejection or my sense of unworthiness. Both play a big role for me.

My friend Joyce gave me an excellent list to use as a tool when asking for something. Here are a couple of things the lists suggests:

1) Be clear about what you want
2) Listen for alternatives or compromises
3) Do not apologize for asking
4) Do not act helpless
5) Do not whine
6) Do not exaggerate or downplay the importance of your request
7) Decide in advance that a “No” answer may have nothing to do with you
8) Do not blame or lecture if you don’t get what you want
9) Remember, your request is worthy even if you cannot get that need met the first time you ask

This is an excellent starting point for asking for what you want, but it begs the question as to how I get to the point that it feels so hard to ask for anything. Why do I think that others will be angry with me if I ask for anything for myself? This is one of the quotes in the paperwork that Joyce shared with me: “At all costs, I must avoid making statements and asking questions that might make me look ignorant or stupid.” Wow, did that jump out at me. I could almost hear my step-father’s voice. His favorite word was “asinine”. My questions were almost inevitably asinine. I have no idea if he actually thought what I asked was stupid or if he didn’t know the answer or if he just didn’t want to be bothered. In any case, my questions were almost always asinine. It doesn’t take too long to learn to quit asking questions in those circumstances.

Joyce tells me that her mother often said, “Don’t bother me.” Through this experience she learned that she was a bother and to this day hates to “bother” people.

Here is another quote that jumped off the page. “I must be loved or approved by virtually every significant other person in my life.” Yikes! Here’s the real kicker. “My past history must determine my present behavior and because something once strongly affected my life, it must affect it indefinitely.” Bingo!

In my head I’m singing “Let the sun shine in.” Remember the Age of Aquarius? Yeah, I know, it’s been a long time but maybe it’s finally time for Jupiter to align with Mars again and for Edythe Ann to ask for what she wants. It could happen.

FOOTNOTE: I have decided that the very best “thing” anyone can offer is their time. Offer to be a personal assistant for an hour or ninety minutes. Specify if you have specific skills at cleaning, organizing, garden work or are just willing to show up and help where needed. That might even include serving tea and talking for an hour or so. If you bake the best pie in the valley, ask when it should be delivered. Sometimes, even if it means doing something you don’t like all that much, you could just put yourself in neural, show up and do it. It’s only for an hour after all.

.

Chemo Treatment

Those of us who have had or are having chemo therapy treatment take it for granted that everyone knows what we are talking about when we say, “Another chemo treatment down, two to go…”

Let me take a little time to describe just what a treatment involves. Yesterday our appointment was at 11:40 am. We showed up a few minutes early and waited to get my blood draw. That would tell the doctor if my blood counts were high enough for my body to tolerate a chemo treatment. We didn’t have to wait long for the doctor to come out and fetch us for our consult. Dr. Cho is so personable and easy to talk to. He says my blood counts are still within acceptable range although I am a little anemic; nothing to cause a delay in treatments.

SIDE BAR; He expressed his regret that he could not endorse medical marijuana for me but said he had no objections to it if I could find a doctor who would support it. Maybe my primary doctor, Dr Barker would be amemable. I left a message for Dr. Barker, but no return call yet.

After meeting with Dr. Cho and having a brief check up, I’m ready for chemo. The waiting room is crowded with chairs and puzzle tables. Patients come and go with various cancer evidence to identify them as fellow cancer patients or caregivers: water bottles, bags of things to distract them during treatment, shocked faces, resigned faces, bald heads, wigs and scarves. Some of us are puffy from the steroids that go with the treatment, some are gaunt with depleted systems showing on faces. The “professionals” whiz by us at twice the speed most of us can muster. The caregivers try to maintain solicitous concerned demeanors through the boring wait time. We waited quite a while before tentatively reminding the nurse that it was two o’clock and we had bee there since 11:30. After a flurry of activity to find my “lost” file, we were finally escorted into the chemo suite. This is a large room with a big work table in the middle for all the many necessities of chemo. There appeared to be two technicians/nurses on duty and they double teamed me getting me set up with an I.V.

For once, we had a semi private chemo area. The room had originally been set up with chemo stations around the room with partitions between each station. Over time, the stations had been converted to contain two and then three chairs. Previously, we had been consigned to the third (middle) chair with scarcely any room for the staff to move around, let alone have Chuck sit comfortably beside me. We felt like we had graduated to this higher status at last.

The first part of the procedure is to find a working vein. That takes a couple of tries. Finally “we’re in” (“we” are not happy with the multiple sticks, but are glad to be done with the search for a free flowing vein). I’m hooked up and ready for the initial saline drip. Chuck asks for a blanket and pillow and tries to make me comfortable.

They still haven’t found my missing file with the orders from my treatment. They are working on it. The orders finally arrive and I get my Emends which is a terrific anti-nausea drug. It’s in the collateral drip and things are finally under way. This calls for a root beer popsicle. Next comes the Cyclophosphamide (Cytoxin) and then the last thing is pushing two vials of doxorubicin (Adriamycin). The nurse can’t get “a good return” so has to find another vein to push this last dose into. After that a little more saline and we are on our way.

I remember my friend Donna called Doxorubicin the "Devil Drug". I'm not sure if that was because it is red or because it made her so sick. The only think it does to me is make my urine bright red. Disconcerting the first time it happens. Donna lost her battle with ovarian cancer some years ago now but not due to any lack of will or effort. She fought like a deamon and could walk and talk faster than me on her worst days. I still miss her.

Finally, I am full of drugs and popcicles and still feeling pretty good. It's hard to complain after a treatment is finally over. We just want to get out of there. Still, I wish the center had a more spa like atmosphere and I wish no one had to go there, but other than that, things are fine and life is good.

Three down and one to go…

.

Ondansetron to the Rescue

I’ve had a bad few days. Wednesday, my friend Carol and I went to Gervais Salon to treat ourselves to pedicures. Mine was spoiled by an onset of nausea. Fortunately, Carol was driving and took me back to her house where I could barf and rest a while. I slept for an hour and thought the queasiness was lifting but we decided to skip our lunch at BJs and have me drive straight home. I made it home in time to be sick again and fell into bed. I stayed sick for the rest of the day and all night and called the doctor’s office Thursday. I was told to continue taking the Ativan and Compazine, melting them under my tongue rather than taking then with water and see if I didn’t feel better. I asked about the option of medical marijuana but was told that the clinic does not support that alternative. Oh, well, there may be other ways. I just wasn’t up to exploring them then.

Chuck spoon fed me yogurt and got me to drink as much water as I would manage at one time.

Another night of nausea and pain and I was back on the phone. Forgetting, of course, that it’s July 3rd and so the office is closed. I was referred to a Dr. Glenn Buchanan who was on call and phoned in a prescription for Ondansetron to Safeway. Bless Safeway for keeping the pharmacy open today. I am to take this pill by letting it dissolve under my tongue. Dr B. advised that if I don’t get relief, I should go to the emergency room and get something via I.V. in addition to getting re-hydrated. I took the tablet two hours ago and so far no vomiting, nausea, significant headaches, constipation, diarrhea, stomach pain, etc. Sometimes I wonder if it’s wise to read these warning lists they send home with the prescription.

I’m hoping for the best but am glad we have a back up plan if it doesn’t work. Cancer Sucks!!

.

I Am So Jealous of Kelly Corrigan

I recently finished reading Kelly Corrigan’s “The Middle Place”. I do truly envy her. It’s not just that she had completed her breast cancer treatment and wrote a book about it--although that is certainly enough to provoke a certain amount of jealousy. The thing is she has this amazing family. Her father, alone, is enough to awake the green eyed monster in any woman. He dotes on her, adores her, lavishes praise on her and thinks she is wonderfully amazing. He calls her “Lovee”. It makes me wonder what sort of person I could have been if someone ever thought so highly of me.

Kelly has a wonderful family of her own--a loving husband and two young daughters. How she manages to juggle family and life while dealing with cancer is a tribute to her own strength and her belief in her ability to do it all. She adores her parents and her brothers and yet ends living in the San Francisco bay area while they live in Philadelphia. With a family like hers, I would be living in the same neighborhood, if not next door. I would be as hooked on her dad as anyone could possibly ever be on crack cocaine.

Read her book to learn more about one woman’s cancer battle but what you will take away is no matter how long she lives, she already won the lottery because she was extravagantly loved.

.

To BRCA or not to BRCA

It’s been over a week now since my gynecological oncologist convinced me that that a BRCA genetic test would be a good idea for me. This test analyzes DNA to identify mutations in either one of the two breast cancer susceptibility genes. These are called BRCA1 and BRCA2 and they are fairly rare. Women who have the mutation are at much greater risk for recurrence and for ovarian cancer. Since I no longer have my ovaries, that is not a concern for me. However, since my cancer is Type 3 aggressive and triple negative, my options if I do have a recurrence are severely limited.

I found out on Monday that my insurance had denied authorization for the test. This was based on a lack of family history. They require two family relatives with breast or ovarian cancer before they will approve the test. So far as I know, I don’t have any relatives with either cancer. If we were to pay for the test ourselves, it would cost $3,120.00. The representative who called me said they could hold the test for a week to give me time to decide what I want to do.

If I did find that I had the BRCA mutation, I could opt for a double mastectomy and reduce my odds of recurrence to some degree. When I factor in the surgical risks, I’m not sure of the statistical benefit of doing that. In addition, for women with the defect, cancer usually occurs at around 35 years of age. I am far past that landmark.

I talked to my primary oncologist, Dr. Cho, before my chemo treatment on Thursday and he supported my inclination to forego the test unless I get more information about relatives on my father’s side that did have high incidences of breast or ovarian cancers. I don’t really expect that to happen and am content with my decision. The representative at Myriad Labs said I could always opt to have the test at a later time.

I am so fortunate to be blessed with a husband who supports me whether I get the test or opt not to have it. It’s a great comfort to know that so far as he is concerned it’s all about me and what will give me the most peace of mind. We should all have the luxury of that kind of support in our lives.

.

Ow, Ow, Ow! This Sucks!

We have just had a lovely string of visitors: my brother Bill from San Mateo, California; Chuck’s high school friend Dave from Bothel, Washington; my high school friend Ruth and her man Van from Mountain View, California. Wonderful visits and all seemed too brief and over too quickly. The great thing about having company is that it feels so normal. We do normal things and I act normal which makes me feel more normal. We visit, eat, watch movies and talk a lot. Ruth and I even went shopping. It all felt good.

But today I know I need a down day. I need a day to take lots of naps, watch TV and lay on the couch saying, “Ow, Ow, Ow! This sucks!” So that’s exactly what I plan to do.


.

Death by a Thousand Cuts

Every morning it’s a new inventory of aches and ailments. It seems like each and every one has a voice first thing in the morning and somehow they sort themselves out and one gets to be top dog for the day. The last few days it’s been mouth sores and joint pain. This morning my fingernails hurt. What’s up with that? All my eager little fast growing cells are getting killed off and not doing whatever job it is that they have. It makes for some peculiar side effects but the hope is that those equally fast growing cancer cells are dying right along with them. Meanwhile, my teeth feel loose and my gums hurt and things don’t taste like they are supposed to taste.

Last week my head (scalp) hurt. I thought I had head sores but my hair was falling out anyway so we went and got me buzzed. Chuck has been rubbing my head with cream each night and says the redness is already going away. There weren’t any actual sores but I think something must happen at the follicle level when the hair is ready to break off or fall out or do whatever it does and that hurts. Now that my hair is gone, my head isn’t nearly as tender.

Chuck’s hair is gone too. He got buzzed right along with me. It’s our tradition. My sweet hair stylist, Glenda, refused to let me pay her. What do you say to kindness like that? She saved a big lock of hair for me so we can compare the color when I get hair again. My hair was all over the floor and seeing that gave me a worse moment than seeing my naked bald head. We got through it with hugs and my friend Ruth took pictures with her camera since I forgot to bring ours. Lucky for me she was with us and had a camera in her purse. My slower growing brows and lashes won't fall out for a while yet. Somehow that doesn't seem as dramatic and it's actually kind of nice to get rid of leg hair, arm hair and all the rest of the hair on my body. I know it's just hair but I miss it.

PICTURES; The first picture shows me in all my buzzed glory on our deck. The second picture is of me demurely be-hatted with my friend Ruth.
.

Penetrating the Chemo Fog Bank

I mean to write every day. I really do, but the chemo fog inhibits me and I end up doing pretty much nothing. Not that there’s anything wrong with that. Chuck reminds me that my only responsibilities now are to rest, hydrate, eat, take my meds and rest some more. It sounds painfully boring but is actually about all I can manage most of the time. Even that seems more of a challenge than I want to deal with.

Where’s the charming nursemaid with the tea tray when you need her?? She must be on strike or something. Maybe it was the lack of wages and benefits? It's not fun being queen without staff!

It’s been nine days since my first chemo. That means about ten days until my hair starts to fall out. I made an appointment for a buzz cut today. My personal hair expert, Glenda, is not thrilled about doing it but will give me the cut and throw in a scalp treatment. I know I'm right on schedule because my scalp is starting to hurt and the mouth sores are taking their toll. Can hair fallout be far behind? Chuck will join me and get buzzed for moral support.

Yesterday was the first day I was up and fully dressed for part of the day. Quite an accomplishment! The amazing thing is that I haven’t barfed once. I’ve felt nauseous and even gagged a couple of times but no epic barfing. That makes me think I should be feeling better than I am. I’m sure part of the barf control is due to a new med called Emends which I took for the first three days. After that I went on an Ativan regimen with Compazine for back up. The Ativan works and has the additional benefit of reducing anxiety.

I still don’t understand my extreme fatigue. I feel like I’ve been through a wringer. That remind me of when my sister Penny got her arm caught in the wringer on our washing machine. “Oh, yeah,” she’s thinking, “Now you have sympathy for me!” Anyway, it may be the chemo or it may be the drugs but in any case, I’m tired to the bone. I feel like I'm just coming out from under heavy sedation. That's closer than any other way I can describe it.

I'll have my next chemo on June 18 and hope that by then I’ll be feeling stronger. At least I won’t go into the chemo suite thinking that I’ll be throwing up. Speaking of the "suite", it’s not the most pleasant environment, but since I’m only there for three to four hours, it’s tolerable. Sure wish it was more like the lovely chemo spas you see in films and slick magazines. It’s about as functional as a typical medical ward with no privacy and not much TLC. I have to rely on Chuck for that. Fortunately, they have a pantry and refrigerator stocked with juices and snacks and he is willing to go back and forth delivering to me and anyone else who will let him. The woman on one side of me had no one with her and was grateful for the attention and assistance.

Not much else to report for now. I'm still on light fare for the most part. Jello, popsicles, pudding, oatmeal, applesauce, soups, mac and cheese. Kathy says I’m eating my grandson’s diet. Great, I have a seven year old for a dietitian. At least he’s a cute one.

I have one other good thing to mention about today. I had a good dose of excellent “friend therapy”. I enjoyed a nice a long phone chat with my good friend Donna from Redding who always manages to make me laugh. Then my Eugene buddies Dale and Carol came out and distracted me with a nice visit that left me tired and ever so grateful for friends.



.

Alternative Therapies

Today is Memorial Day. That makes it an excellent day for reflection and for appreciating the sacrifices others have made so that I can have all the options that I do. It’s easy to forget how fortunate I am to be able to deal with my cancer in a variety of ways instead of having no other choice but to yield to it.

Today I chose alternative therapies--those being wine, chocolate and good company. Chuck and I met our friends Ken and Scott at Chateau Lorane and we enjoyed their art show and live music while we (Ken, Scott and I) tasted a variety of wines. After that, we drove further north and visited Sweet Cheeks winery where we had more wine and a delightful picnic that Ken had prepared for us. Sweet Cheeks has a view to rival King Estates and that’s saying a lot. It was a perfect setting for a picnic and the weather couldn’t have been nicer.

We ended our tour at another winery and then headed home. I realized that I had spent the better part of a day not thinking about cancer. It feels a little like ending a relationship. The “divorce” isn’t final yet but the process is under way. It’s like that first time when you go a whole day and realize that you didn’t waste a bit of it being angry or brooding about what he did or didn’t do; what he’s going to do next; he’s moved out and it’s over or at least starting to be over. The tumor is gone and it’s time to clean up the debris that’s left but that doesn’t mean thinking about it non-stop. That makes this a very good day!

.

I'll Be Your Captain

Yesterday I saw my chemo doctor, Dr. Cho. I expressed my concern that I don’t have a Team Captain and he said, “I’ll be your captain!” That was very reassuring.

Unfortunately, everything he had to tell us wasn’t so reassuring. He confirmed the good news about my clear lymph nodes and clean tumor margins. Those factors bode well for the success of my treatment. On the other hand, my prognosis is not as good as I had thought. The outlook if my treatment is not successful and my cancer recurs is grim. This is mostly due to the fact that my cancer is triple negative and so the various long term treatments hold no promise for me. There is little that can be done if the cancer does spread to my brain or bones. If it recurs locally, there is a better chance that treatment could work.

Dr. Cho brought up charts and graphs tailored for my age, health and type of cancer and it breaks out this way: One third are cured with no additional treatment, one third have recurrences, one third die of other causes within ten years. (Which, I assume, means they didn't have a recurrence?) If I have chemo, my odds are increased by about 7 ½ %. That puts my survival potential at about 40% -- give or take a percent. That is lower than I would have hoped, but Dr. Cho reminded us that I beat much worse odds 13 years ago. On the other hand, the fact that this is my second bout with cancer indicates that my body is not very good at defending against cancer cells. That is an even stronger indication that I need all the help I can get and for me that means chemo and radiation. To not put up a vigorous defense now would be a mistake and one I don’t want to have to regret down the road.

I will have my first chemo treatment next Thursday, May 28th, with three more courses at three week intervals. Before that I will have a MUGA scan which is a test to determine if my heart is strong enough to handle the Adriamycin again. It is the best chemo for my type cancer, but is very hard on the heart. Since I had it before, we need to be sure that there wasn’t significant damage the last time around. If my heart isn’t strong enough, we will have to consider a lesser chemo.

I was sick and nauseous all day yesterday. I woke up in the night to throw up. I was dreaming about chemo. I don’t know if I felt nauseous and that made me dream about chemo or if I dreamed about chemo and that made me nauseous. The triage nurse, Val, gave us a tour of the chemo suite and it was all I could do not to throw up again. It will be difficult to be there for three or more hours while I have my treatment.

Dr. Cho gave me prescriptions for Compazine and Ativan to take during my treatments and they will put anti-nausea drugs in my drip when I have treatments. They also give a new drug to boost the blood counts. I won’t have to go in for daily shots of Neupagen like I did last time. It’s a small thing, but I’m grateful.

,

Apple Pancakes Defy Guilt

Today was another trip to town for a peek at my arm pit. The swelling is subsiding and the redness is going away. Damon was pleased with my progress. I will go back in two weeks for Dr. K to take a look and determine if everything is healing and looking normal. I have a rather large firm lump developing under the breast incision which Damon says is scar tissue. Great. Just what I need. A new lump!

We had an early appointment so arranged to meet our friends Ken and Frank for breakfast at the Old Pancake House. I got to indulge in a giant apple pancake which is about the equivalent of eating an apple pie by myself. It was delicious and guilt producing at the same time. Fortunately the pleasure outweighed the guilt.

.

Support Groups

I have been checking out support groups. A recent visit to my old gynecological support group in Eugene reminded me why I value support groups. Some of the people were the same and some were ‘newbies’ but they are all struggling with the same disease--just different stages and versions of a fairly similar story. They have a certain look in common. It’s the survivor look. You can see they have seen the dragon and faced him down. It seems impossible that they can look both frail and incredibly strong but they do. Their bodies may be weak but their spirits are fierce. I love their ability to see the stark truth and still refuse to be a statistic. They are courageous and infuse me with their unique realistic optimism. I realize how much I have missed them.

I had lunch with a group of breast cancer survivors. My contact with Reach for Recovery (Sandy) introduced me to this once a month luncheon group. Most of them are years out from their diagnosis and treatment and that is encouraging. They represent a spectrum of ages and a variety of experiences. It seems that all sorts of choices can lead to recovery and a reasonably full life.

The weekly cancer group that meets in Eugene is younger, on average, and most are still in treatment. There is a greater sense of urgency because decisions are still being made and members of the group are seeking information. That group also has a moderator who keeps things moving and on target.

The forth group is a dinner group of long time survivors. My friend Carolyn introduced me to this group. The women are warm and welcoming. As a ‘newbie’ to breast cancer, I may not fit in as well but we are similar in age and attitude. At least that was how I felt after one dinner with them.

I doubt I will want to maintain four support groups although three of them only meet once at month. I do know that support is an important component of recovery for me so I can be a visitor for a while and see which one(s) work best.

.

Fluids tend to congregate

Fluids tend to congregate. It seems they love to find a vacant space and move in. These past few days they have gathered in my arm pit. Not a pretty sight.

Friday we went back to Dr. Kollmorgan’s office and her assistant drained a big vial of fluid from the baseball size lump under my arm where the lymph node incision is. Over the week end, the congregating fluids gathered again.

We went back in yesterday and saw the assistant again. He thought there was no point draining again since the fluids filled the space so quickly. Now, since that the lump is red and angry looking and my temp is slightly elevated, he consulted with Dr. K. and decided to put me on a course of antibiotics. I will go back next Monday for another look and the hope is that the problem will resolve itself.

Meanwhile, I can put ice on it and avoid using my right arm. That’s not terribly convenient. Try putting a cold compress under your arm and you’ll see what I mean. The not doing anything part isn’t as easy as it sounds either. It seems like an invitation/authorization to loaf, but that’s not as much fun as it sounds. If there is something that I want or need to do, I have to either ignore it or ask Chuck to do it for me.

If I felt ‘sicker’, I could just sleep, read and watch tv. The problem is I feel pretty good except for the pain under my arm which is manageable. This seems like a time I could get some things done but instead I’m supposed to take it easy. This is very frustrating. My window of feeling good is going to be wasted because of some stupid congregating fluid. I am not a happy camper and that makes me feel guilty because I should still be on a high because of the good news about my clear lymph nodes.

Okay, deep breath. I am happy and grateful and done whining for now anyway.

.

Good, Good, Good, Good Vibrations

No rabbits died or were endangered in any way in the production of this good, good news. Dr. Kollmorgan confirmed that there was NO cancer in the lymph nodes taken during my surgery. Furthermore, the margins of the tumor she removed were clean and cancer free. I have Stage 2 (2.7 cm tumor), Type 3, Triple negative infiltrating ductal cancer. That’s a lot of information, most of which we would not even have understood six weeks ago.

The bottom line is that the news could not have been better and we are relieved, delighted, giddy and grateful. We know that this wonderful result is due to the prayers and good wishes of many, many people. Had the news been bad we would have simply believed this was a different kind of answer...one that we might not understand but that was still part of some larger plan. There is still a larger plan but while we are waiting for that to be defined we will stick to making smaller plans. Those will include chemo therapy and radiation for purely precautionary purposes. Since my cancer is aggressive, we want to be sure there are no cells lurking about ready to mess with our success.

Meanwhile, it’s ok to be happy while I mend and recover from surgery. There’s a sunny weekend in the forecast and a healing body can always use a little deck time.

.

When Is Cancer Gone?

When is cancer gone? This is a question we discussed at my new breast cancer support group. Is it when you are through with your treatments? When the tests can’t detect it? Is it when you have survived a fixed number of years or follow up exams without any evidence of disease? There is a word for that. NED is the word. No Evidence of Disease.

For some, the answer is never. Once you have had cancer or The Cancer as many call it, you always know in your bones that it is just lurking in there somewhere waiting to emerge when you relax enough to almost believe you are truly cancer free. For others, the first chance they get they put cancer in the past tense and keep it there. “Something that happened to me once, long ago…”

When we first moved to Oregon, three years after my treatment for uterine cancer ended, I still needed that annual confirmation that a CT scan gave me. Still NED. A physical exam, PAP smear and CA-125 added to the confirmation. Still NED. My anxiety levels always soared just before my annual checkup. With the NED confirmation, I could relax for another ten or eleven months before I started worrying again. As the years passed, cancer did become less and less of a presence in my daily life. I allowed myself to think that I was done with cancer. Unfortunately, cancer wasn’t done with me.

I think it is different for each of us but in the end, cancer is only truly gone when you decide it’s gone. As long as it controls your daily decisions about what you can and can’t do or can or can’t plan for, it is in charge. As long as you allow it to dominate your life, it will. Of course, there is no choice when you are in treatment. Appointments and the realities of treatment will rule each day. But once you are done with treatment and there is no longer a schedule, a plan, an activity that serves in the battle—what then? It leaves a hole in your life that is too often filled with obsessive thoughts of cancer. What should you be doing? What should you be eating? Is your spiritual house in order? Every single one of these worries comes back around to cancer. We need to find something better to fill the void when treatment ends. I’ll have some time to think about just what that will be.

When I’m done with treatment, I want to be done with cancer. I want to banish it and believe it so firmly that it is no longer the dominant theme of my daily life. I wonder if that’s possible. Maybe cancer will always be part of my daily thinking and planning but I’m hoping it will play a minor role and not be the star of my story.

.

Caution - Amazon Emerging

In the waking moments there is a brief time when possibilities emerge--when the body is not yet awake enough to take inventory of pains and aches—-when dreams still seem as real as the waking world. That is when we think that something bad must have just been a dream. In that moment, I reach for my breast and find it still tender and compromised. It’s not gone but the shape has changed and stitches define the upper boundary between breast and what? Chest? No, that’s not right. Between breast and all the flesh between there and where the neck starts.

Tape still clings tightly to the stitches and I try to resist picking at it. I don’t want to unravel myself prematurely. The incision is five and a half inches long. The scar will ride fairly straight across the top of my right breast. It has a slight curve that makes it look like an upside down smiley. The scar in my arm pit where they removed the lymph nodes is two and a half inches long. There is another smaller one and a half inch scar high over my left breast where my port used to be. That port made it easier to gain direct access to a vein when I had my chemo thirteen years ago. No one has mentioned a port yet for this round of chemo.

I worry that it will be harder to catch a vein now since they can’t use my right arm. That’s a new rule for me now. No pokes, sticks or blood pressure for the right arm. There is a risk of lymphedema and even garden scratches are to be avoided. I saw a pamphlet. Lymphedema is definitely something to avoid. There are pictures of women with arms or legs that look like elephantitis. Once you get it, it‘s very hard to get rid of it. It’s not fluid that you can just drain away. It’s more like stubborn webbing that stays put once it takes up residence. Something else to worry about…

There is another scar that starts at the top of my right shoulder and extends seven inches or so down about half way to my elbow. That’s from my shoulder replacement surgery. When I look in the mirror, I think I look like I lost a sword fight. Maybe since I am still standing, I should start thinking that I won a sword fight. There’s an image. Conquering Amazon with sword raised high (in my left hand of course). “Hey, you should see the other guy!”

.

All Good News!

My surgery yesterday went wonderfully well. It couldn’t have had a better outcome short of finding out that the lump wasn’t malignant after all.

Dr. Kollmorgan did a lumpectomy and dissected the sentinel lymph node. She found no cancer cells. More testing will follow to confirm her finding but it certainly sounds like good news to me. Chuck and I are both giddy with relief and happiness. Of course the Percocet may get a little credit…

Even with the optimistic findings so far, there will be radiation treatment for sure and probably chemo therapy as well. They want to clean out every stray cancer cell that might be lurking in my body. We will know the schedule after we meet with Dr. Cho May 20th. I will see Dr. Kollmorgan again on May 8th and she will have the results of the tissue and lymph node tests by then. Even if the decision is to do both radiation and chemo, the treatment will be much easier on me knowing that we are just cleaning up rather than trying to control a cancer that has spread to other areas.

This surgery has been one of the “easiest” I have ever had. The pain is quite manageable and my mobility is very good. Of course the Percocet is helping on both counts. I haven’t peeked under the dressing yet but I can tell there is plenty of breast tissue left. One of my expectations was that I might wake with a cavern where my breast used to be. I was prepared and willing to deal with that but am glad I don’t have to. Once the treatments are over, I can think about “rightsizing” leftie, but that is not something I have to deal with now.

For now, I just want to enjoy the giddy good feeling of having so much anxiety lifted from me. I am full of gratitude for the prayers and love of friends. I won’t give the Percocet credit for that!
.

TMI II

I saw a disturbing article in the NY Times yesterday. This is a good example of how too much information can be a bad thing. It’s long but worth reading. Here is an excerpt:

Cancer has always been an expensive priority. Since the war on cancer began, the National Cancer Institute, the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion. And other government agencies, universities, drug companies and philanthropies have chipped in uncounted billions more.

Yet the death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58 percent.

Still, the perception, fed by the medical profession and its marketers, and by popular sentiment, is that cancer can almost always be prevented. If that fails, it can usually be treated, even beaten.

The good news is that many whose cancer has not spread do well, as they have in the past. In some cases, like early breast cancer, drugs introduced in the past decade have made an already good prognosis even better. And a few rare cancers, like chronic myeloid leukemia, can be controlled for years with new drugs. Cancer treatments today tend to be less harsh. Surgery is less disfiguring, chemotherapy less disabling.

But difficulties arise when cancer spreads, and, often, it has by the time of diagnosis. That is true for the most common cancers as well as rarer ones. With breast cancer, for example, only 20 percent with metastatic disease — cancer that has spread outside the breast, like to bones, brain, lungs or liver — live five years or more, barely changed since the war on cancer began.

What has happened? Is cancer just an impossibly hard problem? Or is the United States, the only country to invest so much in cancer research, making fundamental mistakes in the way it fights the cancer war?

Researchers say the answer is yes on both counts. Cancer is hard — it is not one disease or, if it is, no one has figured out the weak link in cancer cells that would lead to a cure. Instead, cancer investigators say, the more they study cancer, the more complex it seems. …The grim facts about cancer can be lost among the positive messages from the news media, advocacy groups and medical centers, and even labels on foods and supplements, hinting that they can fight or prevent cancer. The words tend to be carefully couched, but their impression is unmistakable and welcomed: cancer is preventable if you just eat right and exercise. If you are screened regularly, cancers can be caught early and almost certainly will be cured. If by some awful luck, your cancer is potentially deadly, miraculous new treatments and more in the pipeline could cure you or turn your cancer into a manageable disease.

Unfortunately, as many with cancer have learned, the picture is not always so glowing. It turns out that, with few exceptions, mostly childhood cancers and testicular cancer, there is no cure once a cancer has spread. The best that can be done is to keep it at bay for a while.

As a doctor who tries to be honest with patients, Dr. Saltz says he sees the allure of illusions. “It would be very hard and insensitive to say, ‘All I’ve got is a drug that will cost $10,000 a month and give you an average survival benefit of a month or two,’ ” he said. “The details are very, very tough to deal with.”

This information is upsetting. I’m fairly sure that all of it is “true” but I am so glad I didn’t read it at the time of my previous diagnosis and treatment! If I had, I might have been tempted to forego treatment in favor of a cruise or a beach retreat. Of course either would have been easier, but then I wouldn’t be here.

I have always known that I “beat the odds” but I never realized just how high those odds were. I know that cancer can be defeated with aggressive treatment and I know many breast cancer survivors. I’m very optimistic that I will join their ranks.

This is a good time to remind myself that I am not a statistic. If only one percent survive in a given set of circumstances, we should always remember that we can be that one. So fight the good fight and go to the beach later. That seems like a good plan.


.

Five Days and Counting

I saw the anesthesiologist yesterday for my EKG, blood work and instructions for surgery. Now all I will have to do is stay healthy so that surgery won't be delayed further. This is the first time in my life I have had surgery when I feel good. There is nothing to "fix". At least nothing I can feel. That's a little disconcerting.

I will begin a course of treatment that includes surgery, chemo and radiation--all of which will make me feel bad in one way or another and right now I feel just fine. There is no pain and if I didn't know that there was cancer inside me, I would have no physical clues at all. It's all very odd. I do not dread the surgery, but I do dread being unable to do things afterwards. Oh well. I know I must simply put one foot in front of the other until it is finished and all my treatments are over. Then I can try to reclaim my life and do the things I enjoy.

Meanwhile, we are on several prayer chains covering several denominations including Georgian Orthodox. Prayers traveling up from around the world in Georgia, Oklahoma, Washington, Oregon, Utah, Texas, California... I can imagine God thinking, "Who is this woman anyway?" Actually I’m pretty sure He remembers saving me once before.

Maybe He wants to know if I made good use of the thirteen years He gave me. I hope He approves of some of the things I’ve done, but of course I fell short. I know I could have done better. That’s why there’s Grace and thank God for it!

.

Filters Off

Angry is something I long ago decided to do without. I don’t like how anger makes me feel and anger in others is scary for me. I decided I wanted to be a kind, patient person and then did every thing I could to become that sort of person. Lately, whatever filters I installed to help me avoid anger seem to be malfunctioning.

I don’t know how to handle anger. When I was little, my step-father’s anger was terrifying. It never occurred to me that I could be angry back at him. That just wasn’t an option. My mother may have been angry at times but she rarely showed it. I just didn’t have a model for how to deal with anger. Run away, duck and cover or pacify were my only tools. They have more or less been what worked for me.

I am much more familiar with anxiety. Anxiety feels like a hot rush that makes my skin feel clammy and my heart race. I’ve been feeling that lately and it’s not comfortable but at least it’s familiar. Anger feels a lot like that in some ways. The same hot rush and racing heart but in addition there is a feeling of wanting to do some damage: break things, throw things, drive into a wall or off a cliff. I don’t see how any of these things would help, but it’s what I feel like doing.

I want my filters back.


.

Slash, Burn and Poison

Slash, Poison and Burn. I remember this phrase describing cancer treatment from my earlier bout with cancer in 1996. Cut the tumor out, poison any remaining cancer cells with chemo and then radiate the tumor site “just to be sure”. Of course all this is harming healthy cells right along with the cancer cells so it’s no wonder it’s exhausting and painful. It steals a chunk of your life. Some say it’s a year and others say more. I say more since I still have painful neuropathy in my feet from treatment 13 years ago.

Now I will be doing the whole thing all over again. Thursday, April 16th, we saw Dr. Cho at the Willamette Valley Cancer Center. He’s a terrific guy--patient and concerned and willing to answer any and all questions. The bottom line is that although my cancer is probably only stage 2, maybe even a high stage 1, it is Type 3 which is the most aggressive cancer. Because of that, surgery and radiation will not be enough even if I had a mastectomy and even if the lymph nodes are clean. So the plan will be surgery, chemo and then radiation. Slash, poison and burn.

I can’t help but wonder if it is worth it. What am I trading this harsh course of treatment for? If it gives me an extra few years and those years are of poor quality, it seems like a bad trade. But then the question is what would I not do?

Of course I want the tumor out of my body. So the surgery is necessary. The radiation makes sense because it specifically targets the area where the cancer started and grew. It’s a tolerable treatment. Six and a half weeks of daily radiation of the full breast area with a booster at the end targeting the specific area of the tumor. That’s going to be tiring and tedious; tying up every single week day for a month and a half. But it’s not painful except for maybe the initial mapping and tattoos. So I get to read, sleep a lot and watch tv. Not exactly the worst way to spend most of my summer. Not the best by a long shot, but not the worst.

So it comes down to the chemo. Just thinking about it makes my stomach queasy. That stuff takes me to absolute rock bottom. All the vomiting until I’m beyond empty and my stomach continues to try to reject the poison. I remember sleeping on the bathroom floor with a towel for a pillow so I can be close to the toilet when the next wave hits. Maybe it was passing out rather than sleeping but the thing is that when it is too much to get up and get back in bed, it’s bad.

I already know there are some chemos that are eliminated for me by the fact that my tumor is Triple negative. Tamoxifen is out and several others according to Dr. Cho. We will meet again to talk about what might work for my type and stage after my surgery. Adriomycen is a definite possibility. Probably some sort of combination. In 1996, I had Adriomycen, Taxol and Cis-Platin in an 8 hour drip. Can I do it again? Is it worth it? Statistically, the advantage is not all that convincing.

I think that’s a decision I’ll have to defer for now.

.

TMI

.

We saw the radiation oncologist today. Dr. Meredith Wendland is a lovely, intelligent and compassionate woman and I felt an instant connection with her. She spent far longer than I would have expected explaining options and procedures to us.

She told us that there is no reason I cannot tolerate more radiation therapy. The risks are slight. There is some small risk that the portion of the lung exposed to radiation could be damaged but it would not be significant in her estimation. Any tissue on my lower breast that was previously affected by radiation when they did the full abdominal radiation in 1996, could be at risk for scarring or tissue deterioration/necrosis. Again, that would be rare and treatable with surgery. All things considered, the benefits of eliminating any lingering cancer cells would outweigh the small risks connected with the radiation. The treatment would be daily for approximately six and a half weeks.

On the other hand, if I opt for a mastectomy and there is no indication of cancer in the lymph system, I would probably just have chemo therapy. If there is cancer in the lymph system, I would have the radiation and chemo. In that sense, it is definitely a good thing that we do not have to rule out radiation as an option. I may learn more about this when I see the medical oncologist on Thursday.

We learned two additional things that we did not know before. My cancer is a high grade 3 which means it is very aggressive and it is also triple negative. This refers to the hormone receptor test which shows whether the tissue has certain hormone receptors.

• Hormone receptor test: This test shows whether the tissue has certain hormone receptors. Tissue with these receptors needs hormones (estrogen or progesterone) to grow.
• HER2 test: This test shows whether the tissue has a protein called human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. Having too much protein or too many copies of the gene in the tissue may increase the chance that the breast cancer will come back after treatment.

SOURCE: The National Cancer Institute web site

It sounds like being negative might be a good thing but I am not sure if that is true. One thing they indicate is that Tamoxifen is not an option for me. Since my cancer is not fed by estrogen, the estrogen blocking effects of Tamoxifen do not offer any benefit.

All this doesn’t answer my basic question which is whether to have a lumpectomy or a mastectomy. There are so many factors to consider. Dr. Wendland says that the recurrence rate with a lumpectomy is slightly higher than with a mastectomy but the survival rate is almost identical. The more radical surgery does not necessarily increase survival although it may reduce recurrence somewhat.

The question then is how much insult can my body stand and which treatments are less painful and debilitating with the best long term outcome.

My daughter recommends that I sleep on it and listen for the answer that emerges in the morning. My husband says I already know the answer. The decision is inside me but I’m not ready to stop worrying about it.

I feel like a dog with a bone. I shake it and nudge around it; bury it and dig it back up again. I think I should put it away and see what it looks like tomorrow.

.

Gathering Wisdom

Forget the web. Women friends have more collective wisdom than any site you can find on the internet. I visited my therapist this morning and spent the weekend talking to friends and family. Here are some of the gems I gathered from my conversations:

Ultimately it’s my decision – not only what I do or don’t do but how I handle the whole thing: physically, emotionally, spiritually and mentally.

I can stick my head in the sand and play “poor me” or I can do things that will make the situation better. At least the parts that are within my control; and there are lots of them. Here are some of them:

Exercise

Pamper yourself

Do something you enjoy

Walk the dog

Use guided imagery

Meditate

Do yoga

Talk about it

Take a nap

Write, journal, blog

Be in the moment, noticing and relishing the ordinary

That is all good advice. I’m already blogging, that’s obvious. I walked the dog this morning and I went to my health club and worked out after my appointment with Diane this morning. Ha, and I took a nap this afternoon. I’m getting with the program.

Tomorrow we will meet my radiation oncologist and that may give us the answers we need about my potential for tolerating additional radiation.

Oh, the sun just came out. Time for another walk with Bailey.

.

There is such a thing as too much information

As important as it is to be well informed, I’m beginning to think you can over research things. I just spent half an hour looking at pictures of women with lumpectomies, hysterectomies and breast reconstructions. Definitely not pretty pictures! If you want to look at pretty breasts, check out Playboy or Victoria’s Secret catalogs. It’s very stressful to think of having a boob whacked off but I didn’t expect that the reconstructed ones would be ugly too.

External factors, like how much radiation my body can tolerate, may end up making the decision for me and that may actually be a relief. I’m not sure I want to make the decision and then live with the results if I am not happy with them. A couple of my women friends have had double mastectomies with no reconstruction and say they have no regrets. Maybe getting rid of the cancer is a big enough relief that the superficial aspects of how your chest looks aren’t as important as we make it.

Some think that a mastectomy is more effective because there is less likelihood of a recurrence. Here’s what I read about that:


If breast cancer is detected in its earliest stage, treatment results in a 10-year survival rate (that is, percent of women still living) of more than 90%. Long-term survival is similar whether the woman chooses lumpectomy or mastectomy. The difference between the treatments is the risk of recurrence locally (in the breast or on the chest wall). The 20-year risk of local recurrence after mastectomy is 3%-5% compared to 15%-20% after lumpectomy and radiation.

Source: emedicinehealth.com

To me that sounds like an increase of 10% to 15% in the odds that you will have a recurrence with only a lumpectomy. Of course that is recurrence, not survival that they are talking about. But undergoing treatment again? That's not very appealing. Is that enough to swing my vote? Maybe.

.

More Waiting

“How can they just keep me waiting and waiting?” I asked Chuck yesterday. “That’s easy,” he replied, “They don’t have cancer.”

Fortunately, the waiting was rewarded at 1:10 pm yesterday. After Chuck and I had agreed that I would call them if we didn’t hear anything by 1:15! I have an appointment with a radiation oncologist on Tuesday (April 14th) and with a medical oncologist on Thursday (April 16th).

I called to schedule my surgery but of course had to leave a message. Just before 5pm I got a call back saying that earliest Dr. K could do my surgery was April 28th. Dr. Schauer didn’t have anything open before that date. So now I have to wait 18 more days before getting surgery. How is that possible? I wept with frustration. There is no one, NO ONE, available at ten minutes to five to talk to a distraught patient. I left a message for my Patient Navigator, Paula, and for the Social Worker at Willamette Valley Cancer Center. Both gone for the day. It is, after all, Friday and they have lives.

Do I settle for a lesser surgeon, assuming I can find one, who can do the surgery sooner or hang on in this awful suspension for eighteen more days? By Monday when I can actually do something about it (assuming that is even possible), it will be a mere sixteen days.

.

Hurry Up and Wait

We waited all day yesterday for a call from the Radiation Oncologist. I tried calling them but they won’t make an appointment until they receive a referral and they say they have not received Dr. Kollmorgan’s referral yet. I asked if there was a fax number where I could have my radiation records faxed if I could track them down. No, says Dana, they will take care of all of that. ARGHHH!

Not being one to wait, I searched through my old medical records. Yes, I do have my records from 1996. I also have copies of all my tax returns since 1958. There is a word for that, I know. Anyway, the outfit that did my radiation no longer exists, but there is a radiation place with a new name, address and phone number. I contacted their records department and was told they don’t keep records for over ten years. I left a message for the head of the records department, Jennifer. A short time later I got a call back from Jenny who tells me that the records indicate they do have a file on me and she has ordered it from storage. She should have it tomorrow so when the local radiation records office contacts her she can fax it to them. I wished for several minutes that I lived back in Olympia!

This is My MSN horoscope for today

Your mind is buzzing around like a bumblebee, dear Cancer, and you are apt to find that there is very little you can do to slow it down. Make sure you link compassion into the chain that is working to hold everything together. Also be sure that you don't become a victim of your thoughts by losing control over how you act, simply because the voice in your head has taken over completely.


Sometimes horoscopes get it just exactly right. It’s a little spooky and helps me ignore it when they get it exactly wrong. Is it ironic that my sign is Cancer? Maybe just a little bit.

.

First contact with Dr. K

Today was my appointment with Dr. Kollmorgan and we didn’t come away with “The Plan” as I had hoped. We did meet with her after a prolonged wait in a tiny consultation room and our first impression, besides the wait, was very good. Considering the size of my tumor, a lumpectomy is the recommended course of action. That would be followed by radiation and then chemo if indicated by lymph node results, etc.

The question now is just how much radiation did I have when I was battling cancer in 1996? How will that affect current use of radiation? She didn’t have the answers for that and referred me to a radiation oncologist. I will have to meet with him/her and to determine if I am eligible for additional radiation or need to have a mastectomy followed by chemo.

So I can’t schedule surgery because we are not sure which surgery I will need. We will have to wait for answers from the radiation specialist and then go from there. It is frustrating to have to wait but better to know now and get the correct surgery than to find out later and have to have a second surgery or to opt for the mastectomy and find out later that the lumpectomy would have been a better option.

One good thing is that both of us like and trust Dr. Kollmorgan and that is a big step in the right direction.


.

How Many Times A Day?

How Many times a day do you touch your breast? If you are like me, the answer is probably seldom or never. It had to have been a long time since I touched the particular spot where my lump has made its home. Yet here it is. Big as a walnut. How long did it take for it to get that big? Why did my ob-gyn oncologist miss it when she gave me a breast exam just a few weeks ago? Why after all this time of not knowing it was there do I find myself checking to see if it is still there?

My fingers know exactly where it is now. They go straight to it like the tongue exploring the place where a tooth once was. I check to see if it’s growing or changing. Is it more or less dense? Even if it disappears altogether, I will know it is because all the cancer cells leaked out of the pin prick holes left by the needle biopsies and even now they are spreading throughout my body. That is probably extremely unlikely and not how cancer spreads but the image persists. Those cells have been there for a long time but the difference is that now I know they are there.

Cancer can be so tricky and insidious. It can grow at a snail’s pace or run amok like a shipload of sailors set free after months at sea. I’m fairly sure mine would be of the running amok variety. Now I will have to imagine my tumor as a tight little brig holding those restless sailors inside until the surgeon can cut the nasty little bugger out with a full complement of sailor cells intact. Then they can run amok in a nice little petri dish in some lab. They won’t be feasting on me after all.

So the lesson here is this: Touch them, feel them, get to know then well. Examine your breasts as closely as you check out those crow’s feet around your eyes. Early detection is the best defense against breast cancer.

Now I’ll put my soapbox away for today.

.

Garden Therapy

Yesterday my dear friend Dale came out and we worked in the garden for a couple of hours. It was a glorious day full of the promise of spring. We quickly shed our sweatshirts and dug, planted and trimmed with great enjoyment. I used soil from my oldest compost pile and found it to be laced with beautiful fat earthworms. What a bonus! I expected the soil to be good but the worms were a wonderful surprise. These little soil engineers will keep working longer than the Energizer bunny. We were tired but satisfied when we shook the dirt from our gloves and shoes. Our labors were rewarded by lunch at our local Mexican restaurant. We deserved and enjoyed every calorie.

The weather forecast is for more glorious weather today so I will be outdoors getting strengthened by Mother Nature’s garden therapy. Anything seems possible in the garden. All the plants are bursting with energy, pushed by a spell of warm weather and sunshine, ready to bud, bloom and produce. They are eager to fling their beautiful bounty to the universe. How can I be discouraged or fearful when I sink my hands into the soil and see all that around me?

My network is active and beautiful messages continue to arrive in my in-box. They are eloquent, heart-warming and full of so much encouragement and support. I received this brief but powerful message from our friend Guram, half way around the world in the far away nation of Georgia:


Maintain high spirits and resolve. We are with you. We will see you soon in fine fettle. Much love, Guram

Like a Pearl in a Gooey Oyster

My friend Helen P. wrote this to me in an e-mail. If this doesn’t cheer you up, nothing will! I’m copying with her permission.

Dear Edythe,
You are in our hearts like a pearl in a gooey oyster, like a five dollar bill in the back pocket of your jeans, like a primrose that pops up pinkly beside the path, like a butterscotch in the bottom of your purse when you need something sweet. You are a gift, an ordinary miracle, a friend of the heart. Let our love surround you and hold you up. We are there for you.

Pre-TSD

In the morning I want nothing more than to pull the covers over my head and go back to pretending that breast cancer is just a bad dream and I can create a good dream to overlay it and make everything all better. But, no, I have a dog.

My dog Bailey must be fed and medicated on a regular schedule because she is diabetic and the consequences of ignoring that are too dire to describe. Suffice to say that if she is not fed and medicated on time she seems to have a near death experience that is much too scary to risk. Once she is fed and has had her insulin shot and eye drops, she MUST have a walk. A real walk. Not just a stroll up the block so that she can relieve herself. She must go all the way to the river and find just the right spot for her morning poop.

So I get up. I am not always happy to get up but once I am up and active things generally improve. The walk gets me going and lifts my spirits. I make my mental “to do” list for the day and we are both better for the experience. Not today.

Today it rained. That’s not unusual in Oregon and rarely disturbs our routine. The problem is that when we get back, Bailey is too wet to come in the house. I open the garage, drape my wet coat over a chair and leave her to dry off near the garage heater. I want to have my breakfast and read the paper. She wants in. She claws at the door and howls. She whimpers. She cries. Normally, I would dry her off and let her in but today her behavior made me furious. Instantly I decided I didn’t want a dog any more. I didn’t want to deal with her needs. I felt like howling and whimpering right back at her. Keeping up with Bailey’s routine has seen me through recovery from uterine cancer treatments, several surgeries, illnesses and depression. But today I didn’t want any of it.

My husband rescued her. He toweled her off and let her in and left me wondering what on earth had made me so angry. It was so out of proportion. I think I know all about anxiety and its various symptoms but, for me at least, anger has never been one of them. So this is a new variety of anxiety for me. I have even given it a name. Pre-TSD. I am experiencing pre-traumatic stress disorder. I feel better now that I have named it.

Visualizations

My friend LaVae reminds me that visualizations are an important part of treatment and recovery. As one goes through the various procedures, it is good to create an image of the cancer weakening and being destroyed. This is a very personal process and it should be an image that each individual can create and recall as they navigate their individual cancer journey.

I have decided that my image will be like the Verizon ads: a vast sea of individuals all there to back up your phone service. Only in my image they will be there to support me and help me defeat cancer. Each of my network of people will be working on my recovery by providing me with love and encouragement; saying prayers and putting me on their prayer chains; researching treatment options and doing whatever they can to ensure I get excellent reception and service every step of the way.

During my first bout with cancer in 1996, I envisioned the chemo as tough and feisty enforcement guys cleaning up the neighborhood and kicking out all the radical misfits who were actually weak little punks. These puny bad guys didn’t stand a chance against my chemo-cocktail fueled enforcers. They cleaned up the neighborhood and had radiation guys go in behind them to make sure not a misfit was left. They did a heck of a job and I may call on them again but for now I’m liking my vast sea of support people. “Can you hear me now?”