Tuesday, December 05, 2006

There and back again

Here's what I did on Sunday: I played a game of volleyball on the beach.

Doesn't seem like much, but I haven't played a game of volleyball since March. The twelfth, to be exact. The day before I had surgery.

Damn, it felt good. And I didn't even suck (much). My surgery arm--the one for which I have to be vigilant against lymphedema--got pink, but didn't swell. I stopped after one game, but next week I'll play two.


Even after going through it myself, it is really hard to fathom just how much chemo takes out of you. I remember struggling to walk up the stairs in our house: gripping the handrail, lifting each foot heavily onto a step and pausing to rest before continuing, feeling my legs quake as I asked them to work that hard. One day, Noah--seeing how bored and sad I was, and wanting to help--played cheerleader and tried hard to convince me to go see a movie. It sounded like the most exhausting idea ever; I couldn't imagine having to sit upright in the chair for that long, let alone make the trip to the theater. The other night, we went to see a movie and it was so feather-light; the farthest thing from exertion.

I look back and shake my head. It seems impossible that a movie was too exhausting even to try. And it happened to me. If anyone out there knows anyone going through chemo, please remember: the experience is really unimaginable. Some days there won't even be a movie. But if all goes well, in the future, there may be a volleyball game.

Thursday, November 23, 2006

Giving thanks

I’ve always thought about reasons to be thankful at Thanksgiving, but this year my feelings are amplified.

I’m thankful that I’m done with the 7 months’ journey that I took this year. I’m thankful that I feel better, healthier, stronger. I’m thankful that my 3-month check is negative, and that I hear new stories every week about some woman who had breast cancer once, and never had it again. I’m thankful that my hair is returning.

I’m thankful for great doctors and incredible nurses and insurance that lets me get whatever they say I need.

I’m thankful for all the friends who were better friends than I knew, who called and came over and sent e-mails and made sure I was hearing them even when I wasn’t reaching out to them—especially Maia, Christina, Alexandra. I’m grateful for an extended family, part of which I only gained 6 years ago, who offered everything from moral support to medical advice (Andrew) to some of the best cancer quips (“fucking bad news!” –Steffi) I’ve heard.

I’m thankful for books on tape from Bernadette and Lara, for Harry Potter movies from Alison, the Gilmore Girls from my mom, books from Judy. I’m thankful for flowers from my mom and dad, Chris J. and Melody, Chris D, Rick and Joanie. I'm thankful for scarves and good body-smelly things from Sarah. I'm thankful for Lissa's care package, with comic books and candied ginger and great CDs. I’m thankful for the juicer that Maia, Alison, Lara, and Ena all sent to keep me healthy and hydrated during chemo, and the book of juice recipes that were as yummy as could be. I'm thankful for the DVD player from Mom, Dad, and Dan that kept my mind off the needles every two weeks. I'm thankful for Rick and Joanie's four-leafed clover, and the acupressure wristband that staved off nausea even on the worst days.

I’m thankful for the cards, e-mails, and notes from so many people that I won’t even try to list them now, because I’m worried I’ll leave someone out, and everyone is so important to me. But later, I’ll go get all those cards (I’ve saved them all!) and come back and edit this post to include every name.

I’m thankful for the comments on my blog, which let me know that people were keeping track of me and interested in how I was doing.

I’m thankful for my parents, who cried on the phone when I told them my news, and then stiffened up just as strong as they could and insisted on being there for my surgery, washing my hair afterward, doing whatever little errands and help they could find. They answered the call when I was in the darkest weeks of chemo, each coming out for a full week to keep me company and bring me cheer and do more errands. They sat on the loveseat while I lay on the couch, ensconsced in pillows and misery, and talked or read or just were present. They sent flowers every single week. They kept track of every date. They hugged me and their arms told how much they loved me and wanted me to heal.

And I’m thankful for Noah, who had his own 7-month cancer journey by my side, and who travelled it carrying my burdens along with his own. I’m thankful for how he tried to give me ease in every way: going to every medical appointment, bringing me popsicles and drinks during my chemo drips, shaving my head for me when the last bit of hair had to go, holding me when I was desolate, playing Battleship when I was bored, making countless trips to the grocery store for the one palatable thing, making that call to my parents when I was really down, urging me to exercise, to get out in the world, to live life throughout treatment. He bit his tongue when he wanted to argue, bowed his head when I was short-tempered, and never looked at me differently when my hair was gone and my chest was a little lopsided. He celebrated the end of chemo, then the end of treatment, with as much ferocious joy as I did. I know that a lot of women face double the stress when they deal with cancer, because they have to fight not only a medical battle, but a whole bunch of personal ones, too. Noah was the strongest of a whole phalanx of people who encircled me in a web of linked arms, making sure that, while I might be jostled around a bit, I would never fall.

I can certainly feel sorry for myself, I can ask “why me,” I can resent the hell out of this experience. But it has also shown me how much I have to be grateful for, and this Thanksgiving, it’s so much that I can hardly contain the gratitude. So thank you all, and I wish you as much joy this year as health, as friends and loved ones, as the beauty of life, can bring.

I keep remembering kindnesses not mentioned here, and coming back to add them--so if I have unforgivably not mentioned one of yours, please check back! I'm editing a lot!

Monday, November 20, 2006

A thump in the chest

It hits at the oddest, most unexpected times. Steffi told us that cancer cleaves your life in two. There's no longer one long, smooth, unbroken track; instead, you have BC (before cancer) and AD (after diagnosis). And once you fall, sprawling, over the rut into AD, you can never go back again.

So I'm reading a great little piece in Salon about giving thanks at Thanksgiving, and the clarity and wonder that come from living past cancer. A very nice piece, and I completely agree. Then I look at the letters, and one woman writes that she is grateful for never having had cancer.

Which is when I get the thump. Because, unlike the letter writer, I have had it. I know lots of people who haven't--far more who haven't than who have. And I used to be able to have that same relieved, satisfied little feeling of being one of the ones on the good side. Now I have to check that box on all the doctors' forms, and I have to claim that history (in both medical and symbolic senses). Boo hoo, me.

Yes, before you rush to reassure me, this glumness is accompanied by the recognition that I still have the thing to be grateful for. And maybe it's even more profound. To walk with death, and come out still alive; where would all our heroic tales be without that? The Salon article itself talks about how life AD is a little sweeter, a little clearer, for the darkness that we pass through to arrive back at life. I get it, and more than intellectually. I do feel deeply, profoundly grateful, and the world is definitely bright. I love feeling better every day. I love being back to my life. I love how much I appreciate it, and how I can dismiss the little annoyances, because of the past 8 months.

But still the sense of loss. Cancer is the gift that keeps on taking.

Saturday, November 11, 2006


For much of my life, I've been relatively glad that I haven't won (or played) the lottery. That's right. It always seemed to me that I had pretty darned good luck, but in a mild way; and I worried that any exceptional good luck (like a multimillion jackpot) would have to be offset by a commensurately horrible experience.

As you can imagine, since March 13, I've been thinking that now is a fine time to start playing the lottery.

My diagnosis was a piece of really crappy luck. And everything that has happened as a consequence is stuff that I would happily forego, if only I didn't have to have this diagnosis. And yet, it turns out that the luck baseline changes once the diagnosis is here. Although it's always sounded ludicrous to me that flood victims, for example, praise God for getting them through the flood alive (I think, shouldn't you be pissed at God for sending you a flood??), now I understand. A horror strikes, and you don't get to use your old frame anymore.

So then, I think, I've been very lucky. I was lucky that the tumor was only half the size that the doctors thought before surgery. I was lucky that there was no spread into my lymph nodes, and no metastasis. I was lucky that my veins held up to the chemo, and I never had to get a port or a pic line. I was lucky that my skin had no problems with the radiation. I was lucky with timing: we delayed the start of chemo until I finished teaching in spring, and I started teaching in fall two weeks after the end of chemo. So I lost a summer--but I've otherwise been able to stick to the normal seasonal schedule of my life. And I was lucky that it was summer when I had to sit nauseated on the couch, since I was not expected to be anywhere by my job, and could continue getting paid without having to take formal leave--working when I could manage to. Think of the incredible luck, and luxury, of that.

And I've been phenomenally lucky--in the sense of "the harder I work, the luckier I get"--because I am well insured and had planned well. Two years ago, we switched insurance plans into the most powerful and flexible PPO that USC offers. This year, I'd put extra money into our medical spending account (thinking we'd get lots of eyeglasses and physical therapy). Also, though I didn't end up needing it, I signed up for the supplemental disability plan. All of this means that I have had virtually no financial concerns through this whole process. My out of pocket maximum for the year is just $1000, and much of that was covered by the spending account, so we've probably written less that $200 in checks so far. If I needed to go on disability, I would get something close to 6 weeks at full salary, and after that would get over 50% of my salary.

I contrast this with the experience of my aunt, who has had to go through treatment for cancer without private insurance, and who has had to forego certain treatments or certain drugs--or be told that she can't be treated with a new protocol until she gets substantially worse, because that protocol is so expensive that it can be provided for her only if her need is dire. She owes tens, if not hundreds, of thousands of dollars to her oncology hospital, and the only asset she can maintain as a result is her home.

Cancer treatment is brutal and unhappy anyway (even if I sounded chipper). When I hear other people's horror stories about insurance denials, high bills, and struggling to work throughout chemo, I feel astonished and relieved that things have been so "easy" for me. Lucky, lucky.

Oh, and last week I had my first three-month check--blood tests and physical exam. I got the all clear until late January. I'm in Philadelphia at a conference, feeling energetic and healthy and fully involved in my life again. Lucky, lucky.

Monday, October 16, 2006


Haven't posted since the end of treatment and thought I should check in briefly. I'm doing well; haven't been sick again (knock wood) and my energy is coming back steadily. Another hair update soon, I think. I've been out in public a couple of times with my GI Jane look, though I still don't really feel the head's ready for viewing.

A couple of nights ago, I was at Whole Foods and, as I got back to the car, saw a woman in the parking lot with a bandanna covering hair like mine. I was wearing a wig, but wanted to whip it off and call out, "Hey, look! Me too!"

Having cancer has made me a lot more aware of the many difficulties and tragedies that people all around us face. (Also, when Noah and I watched a 9/11 documentary, we saw a guy who was in one of the stairwells when a tower came down, and he rode that stairwell down in the collapse--something like 60 stories--and survived. I thought about him walking around in the world, mingling with thousands of strangers who have no idea what he's been through--no idea that he survived the collapse of the twin towers.) It's impossible to see what people have survived, what they are currently enduring. I wish we all wore big signs: "In treatment for breast cancer"; "Parents died in a plane crash"; "Currently nursing my husband through terminal illness"; etc. Yes, it may be macabre, but it just seems like almost everyone has faced tragedy, and deserves tenderness, and yet we are all so oblivious to everyone else's pain because we just can't see it.

Friday, October 06, 2006

Light candles and hope this is for good!

Here's what Noah presented to me at 11:01 am, after I rang the ceremonial "done with treatment" bell at radiation oncology.

Thursday, October 05, 2006

T-minus-27 hours

One more radiation treatment left.

We had a hiccup on Tuesday, when I arrived for my appointment and was told that the machine was down. It couldn't be fixed in time for me to make it to class, so I had to skip treatment that day. I really wanted to finish on Friday--can you imagine having to wait the weekend, knowing that your last would be on a Monday? So the dr agreed that I could have two treatments in one day. Today, I got up early and got to radiation for an 8:30 appointment, then went to Beverly Hills to meet the nutritional oncologist at 12:30, and then back down to Torrance for radiation again at 4:10. (I had time to stop home twice, between appointments.)

The rad onc tells me that this week should be the time for my worst skin reaction to the original radiation field, and next week will be the worst in the areas covered by the boost. I do have some redness, and the top of the field looks like I got an odd, rectangular sunburn. The skin's a little toasty--leathery--the way sunburned skin can be, but still not too bad, and if it starts getting better from here, I should be fine.

The meeting with the nutritionist went great. She said I'm doing really well (18 lbs down, reflecting a slowdown this week--but she says this is a really fast rate compared to most of her other patients). My goal has been adjusted a bit--I have another 18 lbs to go, and she may still push me further after that. I don't go back for another 8 weeks. Since it took me 8 weeks to lose the first 18 lbs, I hope to lose the next 18 lbs in the next 8 weeks. It'll take some work!

After my last treatment tomorrow, Noah and I are having a celebration day. We'll go to brunch at the North End Caffe in Manhattan Beach, one of my favorite places--a place I've not patronized since my diet started. I'll be cheating on the diet tomorrow, for sure. Then we'll go for a hike in the Santa Monica Mountains, then back down to the South Bay for dinner, and then (of course) the Battlestar Galactica premiere. I'm looking forward to a day of self-indulgence; the next day, I'll be back to my refraining ways!

It is really kind of amazing how much support there is out in the world these days for cancer patients. First, there's the Wellness Community, where I've attended support groups since my diagnosis. They also offer all kinds of classes in yoga, visualization, nutrition, and other mind-body boosts, and all of it is free to cancer patients and their families. Now that I'm almost through treatment, I've been interested in getting back to physical condition, and it turns out there are more great (and free) programs for that, too. Spectrum health clubs offers a "Cancer WellFit" program that gives a 10-week class to help us get back into shape. I start mine on October 16. There's also an organization called Team Survivor that provides group exercise classes--even triathlon training!--to recovering patients. And yes, it's free.

Finally, it is Breast Cancer Awareness Month. I'm certainly aware of breast cancer, and I assume anyone reading here is, too. Of course I want all the women I know to do the self exams and the mammograms and yada yada yada. But also watch your weight (huge risk factor!) and enjoy your life every day (not a risk factor, but something we can fail to do until a calamity knocks us on our ass). I hope everyone can keep their awareness firmly anchored in the 3rd-person perspective.

Monday, October 02, 2006

Photo Monday! -- Diet update

How's the diet going? See for yourself.

Photo credits, as always: Noah

Photo Monday! -- Hair Watch 2006

As promised. My hair is growing WAAAAAAAY more slowly than I hoped or expected. Tomorrow makes 9 weeks since the end of chemo (yay), and as of today I still look bald, albeit with 5 o'clock shadow. It's progress, but not arrival. My new goal is to be able to go "topless" by November. Please send all your hairy thoughts my way.

Here's the head today: And the last time:

And just to acknowledge growth where it exists...here's a closeup shot of my eye, where you can see that eyebrow and lashes are actually looking like the real things. By the end of treatment, I had about three single lashes left on the upper lid of each eye, and none on the lower; and I've been down to maybe ten eyebrow hairs, total. Now I can even go easy on the eye pencil, so this really is progress:

Saturday, September 30, 2006

End in sight

I'm down to my last week of treatment. The last week of this 6-plus month journey is here. I've finished the main radiation treatment, and next Monday through Friday I'll have the "boost"--a beam more narrowly focused along my lumpectomy scar. I've developed some redness, though it's very mild, and fortunately next week's treatments will avoid the red areas. Hopefully I'll get out of this round of treatment with minimal scathing.

And as of Friday, October 6 at 11am--I will officially be Done With Treatment. I can move my magnet from the "cancer patient" column to "cancer survivor." I can hardly tell you how exciting that is. Noah and I will be taking the day to celebrate--meals with disregard to diet, blatant ignoring of work, and whatever fun activity we can muster.

And at 9pm--yes, perhaps I have odd priorities in my life--we'll get to see the 2-hour season premiere of Battlestar Galactica, my favorite favorite show. It went on summer hiatus back in March, around the time of my surgery, and I have been looking forward since then to this premiere--partly because I love the show, but partly because I expected all along that treatments would end about then. The confluence is gratifying.

Hair updates soon, I promise! And the diet is still going great--I'm almost 20 lbs down now.

Saturday, September 23, 2006


Two days after my last post, I went to the urgent care clinic in Manhattan Beach, and was diagnosed with a bacterial infection and given amoxicillin. I had to cancel my MBA classes for the first time ever when I could barely speak or walk on Tuesday. And I still have most of my symptoms today, Sunday, two days into Week 3 of the cold.

We'll post new hair pictures soon, because there is visible progress--although again, it's 7 weeks after chemo, and I thought I'd have a lot more hair by this time. Eyebrows and eyelashes are coming back well, though they're still stubby. Basically, I am making forward progress, but it is very, very frustrating how slowly that progress occurs--and how many steps backward I have to take on the way. The cold is a prime example. It really sucks to get so sick when I expected to be healthier and healthier.

I've heard many people say that things get harder after treatment ends, before everything gets easier. That is starting to make a lot of sense to me. I am still 2 weeks from the real end of treatment, but I want my life back NOW, and it doesn't work that way. Argh.

Saturday, September 16, 2006

Quick update

Things are going OK. I've finished my 3rd week of radiation, if you don't count the one day off for Labor Day (which has to be made up later), so I'm halfway to the end of that treatment. Yay. So far I seem to be responding fine, at least in terms of side effects. I have a little bit of redness, not exactly like a sunburn, but like a little mild pinkness from the first day of summer sun after turning pale all winter. No real itching, which is a common source of trouble (scratching leads to faster skin degradation). I bought a couple of non-underwire bras, due to the edict of the rad onc, but one of them is actually more irritating than my underwires. And I've had some heavy-sleepiness kind of fatigue, which I can't be sure I should blame on radiation. It generally hits after a long day of teaching and meetings, and may just be because of that. So, in general I am doing fine with regard to radiation.

In other ways, though...not so good. I got a cold 9 days ago, immediately after a wonderful massage. Massages often stir up toxins in the body and you get flu-like symptoms, and this was really minor at first. I didn't have to take much downtime and was able to teach and attend to my duties all week. But two days ago, Noah came down with it in much more serious form, and then last night I was hit with a real whammy. My temperature shot up to 101.8, and the rad onc had said I must call my regular oncologist if it was over 101. So, at 11pm, I was calling the after-hours line at USC for the doc on call. His verdict: it's a viral infection, not what they worry about for chemo/post-chemo patients. I should hydrate and keep pounding the Tylenol/Advil. Fortunately, overnight the fever broke. But Noah and I are both feeling just lousy today. Lots of sleeping and moping, and not a lot of moving. He struggled out the door late last night to get us more symptomatic relief (Nyquil, etc.), but today we both seem unable to do much. Thanks go to his dad, who's in town and who dropped off lunch (which will probably also be dinner--it was big).

I think this is not cancer-related, and not even particularly compromised-immune-system- related. It's interesting to be just "normally" sick again--and hard to avoid letting it take on bigger meaning. The hardest part is that we are both laid low at once, which means neither of us can do the caretaking for the other. I just hope that we both recover quickly (for me, that my body is strong enough to do so). Like I said, our lives today are all about the sleep and hydration. Will let you know how it goes.

Wednesday, September 06, 2006

Dream a little dream

I'm not sure that the vaunted "positive attitude" is always a good thing--but occasionally, I am really comforted to realize just how positive my attitude seems to be.

In the last couple of months, I've had quite a few dreams that are clearly "about" my cancer experience. None of them is explicitly about cancer, or disease, at all. But the symbolism comes through loud and clear. Water has been a major symbol in all but one of the dreams. I thought I'd describe some of them here. Hey, after posting my bald head, why not lay bare my psyche as well? (Hair update, by the way: though it's barely visible, I have an even fuzz all over. We think the follicles are about to burst into bloom!)

Dream #1 (earliest): Noah and I were going to a wedding in Amsterdam and we were all dressed up. The only way to get to the wedding was to ride a "bike" that went not on land but on a water highway. I sat on the seat and pedaled; Noah rode on a running-board-like step just behind my seat. If I stopped pedaling or faltered, we would sink into the water and ruin our wedding clothes. Several times, people around us got submerged to our necks, and I was nervous the whole way; but we made it to the end of the water highway intact and dry.

Dream #2: I was performing in a circus show, and had to stand on a tiny platform up high in the air, supported by a single stilt. The platform kept swaying and buckling; I was terrified and kept moaning my fear to the other (unknown female) performer who was there with me. The circus ringleader shushed me, and forced me to stay there even as my panic mounted. I was sure something awful would happen--it was like my "chased by robbers" dreams, in which the robbers always catch me. But this time, after a period of terror, the show ended, and I was safely brought to the ground. (And then I went straight to the snack vendor for some bread...and this dream was before my diet!)

Dream #3: I was walking along a dock in a marina, and looking into the water, which was filled with menacing looking sea creatures--not sharks, but smaller, spiny things that were a lot more scary. All of a sudden I fell into the water, into the midst of all the terrifying creatures. I thrashed about and kept waiting for an attack, or to be eaten; but then I found steps to get out and escaped safely.

Dream #4 (just a few nights ago): I was in "Manhattan Beach" (looked nothing like the real thing), sunbathing and reading on a rocky outcropping at the coastline. The rocky area was just below an elevated pier complex with businesses. I was enjoying myself in a patio chair, when suddenly a huge wave came in and engulfed me; everything around me became ocean. I later realized it was a tsunami. I barely made it to the slope and up to the elevated area, above the inundation zone. I started back down to retrieve my stuff as the water began to recede, but everything was gone. I was very upset at losing not only my chair and book, but also something else that seemed terribly important, though I couldn't remember what it was. In the midst of my upset, though, I realized I had just survived a tsunami and was thrilled to be OK. I started walking uphill toward home. When I was almost there, I realized my keys had also washed away.

Though the last one had a late "gotcha," I'm really struck by how I always turn out OK in these dreams. I'm really hoping that my subconscious has a read on my overall health that's not accessible to the rest of me!

Friday, September 01, 2006

Diet milestone!

Forgot to post about my 3-week check-in with the nutritional oncologist. I lost 10 pounds in my first 3 weeks! She and I were both very impressed--she kept saying "wow" as she looked at the numbers, and then as she went through my food diary. I felt like I was a little permissive in my interpretation of the diet at times (read: I cheated), but she felt I'd been very faithful to it. Yay.

So--a third of the way there in just 3 weeks. I'm sure the next 20 pounds will be tougher, but at least the goal is that much smaller now.

An interesting note--my nutritional oncologist, Rachel, is also the n.o. working with Sheryl Crow following her breast cancer. (Add that to my surgeon, who operated on Suzanne Somers--I don't think you can dodge the one-degree-of-celebrity-separation here.)

And finally, thanks and welcome to all the friends and family who have joined me, either doing my diet with me or giving up some kind of indulgence themselves. It is great to have the company and support! Let's all get healthy!!

Watching the grass grow

So my hair should start growing back now. Any day now. Annnnnnnnny day.

They say growth starts about 3 to 6 weeks after chemo ends--that's some range! It's been 3 and a half weeks, and if you run your hand over my head, you can feel that it's rough, but not really hairy. Maybe it's like the 5 o'clock shadow of a teenage boy whose beard hasn't fully arrived yet.

Last night I had a great dream. I dreamt that one afternoon I reached up to my head and found hair! It was very dark brown, and curly, and about chin length. I didn't know it was there, but suddenly I was running my fingers through my own hair. Excited, I began telling people how I awoke that morning with beard-like stubble, but during the day my hair had grown out that much. It was quite wonderful. Now, today, I feel so dissatisfied, wanting that to be true.

A month or so ago, in my support group, a woman who'd just finished chemo complained of her own frustration with wanting to be all better, now, against the reality that getting better was a slow process. I sympathized at the time, but I didn't understand. Now I do.

Meanwhile, I am going to start the new Hair Watch 2006. In May, it was a hairloss watch. Now, it's a hair growth watch. It takes a lot for me to do this, but I am going to post photos of my progress (from the back--I do have limits). So here's the first one, taken last Saturday, at zero growth. When there are notable changes, the HW will be updated.

Wednesday, August 30, 2006

Newly-busy days

So much going on! I just wanted to file a quick update here--not as verbose as usual, I hope.

First, I started teaching last week. It's nice to be back in the classroom, actually--reassures me that I can return to My Life, and not be stuck in the life that hijacked me almost 6 months ago. My first day was rough--I have two back-to-back 3-hour sessions on Tuesdays. In the first, I forgot to conserve energy, and went bouncing around the room the way I usually do. About 2 hours in, I was hit with chemo-style fatigue and wondered how I'd make it through the rest. In the second class, I sat on a chair almost the entire time. I told both classes about my health--the first, so we could arrange a plan for any time radiation might make me late for class, and the second, to explain why I sat on my ass the whole time. Interestingly, this week a student came to me to talk about breast cancer (usually it's to ask for job negotiation advice). His mom was just diagnosed and he wanted some reassurance, I think, and some tips for her.

Second, in the few days before radiation started, we squeezed in a quick trip to Yosemite. That, too, was a good return to life. I actually did all of the following in three days: a 2-hour horseback ride, a 2-mile hike (mostly downhill), and a 12-mile bike ride. In the past, this would not have been an especially active getaway for us, but I feel an enormous sense of accomplishment now. Now I just have to keep up the exercise! We got my bike tuned up before the trip, so it's ready to go.

Third, I started radiation on Monday. It is going fine. There are no side effects right away--those don't usually appear until the 2nd or 3rd week, apparently. It really is painless--a bit like sitting on the slide of a giant microscope that buzzes for about 45 seconds. If you're not smashed on the slide, you can imagine, that wouldn't feel like anything. Anyway, I am showering with Ivory soap and deodorizing with Tom's of Maine for the next 6 weeks, and I have an appetizingly-named cream to apply--it's called RadiaGel. Mmmmm.

Finally, since my diet has garnered lots of sympathy and support (thanks so much for that!!!), I'll let you know that I've made it through my first 3 weeks pretty well. At Yosemite, I sometimes had few good options, and I had three meals on our trip that I consider really cheating (fried [!] fish at one, scrambled eggs and waffles at another, a Quizno's sandwich at the third). Otherwise, it was not TOO hard to ask for my fish cooked without any oil or butter, and my vegetables steamed, and extra veggies instead of the rice. So it's worked out, and I've lost at least 5 pounds (maybe more, but that's using different scales, so who knows). I check in tomorrow and we'll see how it continues.

OK, that's it for now. Thanks for checking in. I don't feel "done" with all of this yet and I do appreciate the ongoing support, so much.

Saturday, August 19, 2006

The new chapters open

It would be nice if ending chemo meant ending treatment altogether; ending the "cancer experience" and moving on with life. Alas, it is not so.

The final phases begin now. Radiation will start August 28 and last for 6 weeks; my nutritional intervention--let's call it that for now--started nine days ago and could last for months, if not years.

We went to the radiation oncologist ("rad onc" in oncology ingroup-speak) yesterday. The good news, since radiation treatments are 5 days a week during the 6-week period, is that I will go to a hospital in the South Bay, just 15 minutes away, rather than to USC. On the other hand, I was diagnosed and have gotten all of my treatments to date at USC. I feel an odd sense of dependence on that facility, and I feel uncertain and hesitant about going somewhere else. At the beginning, Noah and I weren't sure we would build a good rapport with the medical oncologist, Christy. In the end, I feel that Christy--along with Michelle and Lilia, the great nurses, and even Dean, who drew my blood perfectly week after week--was enormously caring, and we developed personal relationships and a strong sense of bonding.

The rad onc--an older male physician who did not invite me to call him by his first name, but for the sake of relative anonymity here I'll call him "Tom"--had a meeting to get to, and had a specific order in which he covered issues and gave his spiel, and questions were put off until their appropriate place in the spiel. He was professional but distant, and I won't see that much of him anyway. "Doctor days" are on Tuesdays, so I will see him on that day each week. (As for the fact that that's my long teaching day and thus the worst possible day in which to try to force in another appointment--too bad.) Most of this is psychological--Tom was recommended by my own providers at USC--and I am confident that I will receive top-notch care. But it's a difficult transition. When you are putting faith in people to save your life, I think you develop a bit of bias about them, and it's hard to feel like anyone else could possibly measure up.

So...radiation. The procedure itself is totally painless and quick. I go in Monday for a set-up appointment, where after numerous x-rays and CAT scans and lying with my arm over my head, the physicists will map out the correct angles for the machine to shoot radiation beams through my breast without hitting my heart or much lung. I'll get 2 to 6 tiny blue-dot tattoos in a square configuration to mark where the machine will line up. And I'll get instructions like, don't use deodorant (Tom's of Maine is OK), don't use talc, do use lots of this particular special moisturizer.

When I go in for each daily appointment, I'll lie back in exactly the same position (they use a foam mold to hold my arm in place, and the blue dots for alignment) while the technician spends about 5 minutes getting all the machinery set. Then, for about 2 minutes, the shooting of beams. That's it. This facility is apparently pretty good about getting people in and out, so overall there may be little impact on my days. Of course, it looks like I'll have to go in in the morning, and anyone who knows me knows that's a problem. For 6 weeks, 5 days a week, getting up early? Yikes.

The side effects are supposed to be fairly minimal, but so far every woman I know who's had radiation (there are several in my support group) reports at least some degree of burning. One had 3rd-degree burns. Seriously. Forgive a graphic moment--she had blood and pus oozing out of the area being radiated, and had to apply burn dressings all the time. They didn't stop or delay treatments, either--just kept going, and kept burning her.

No one else has reported anything as dire. In general, radiation seems to produce a sunburn by about week 3, and it gets progressively worse until a couple weeks after the end. Constant moisturizing and vigilance against scratching (which will be hard for me) are apparently key to minimizing trouble. I've gotten advice to wear very soft shirts and to eschew underwire bras--I don't think I've ever seen a bra in my size without an underwire, but they apparently exist--and to apply cortisone cream for the itching. Though fatigue is a standard side effect of radiation, "they" say that it's minor compared to chemo, and that post-chemo patients still just report feeling better and better as chemo recedes into the past.

So radiation will occupy my next 7 weeks; even longer than that will be The Diet. Way back when I got my 2nd oncology opinion, the doctor (very prominent nationally) recommended that I eventually work with the "nutritional oncologist" at her practice, who was part of a large multi-site study of nutrition and breast cancer treatment. If I have my numbers right, the study found that women on a very low-fat diet during or after their BC treatment were able to reduce their risk of recurrence by an average of 24%. For women whose tumors were not sensitive to estrogen--like me--risk was reduced by an average of 42%. All of this implies that my own risk of recurrence, 20%, could be lowered to something like 12-16% by following a similar low-fat diet.

I saw the nutritionist, Rachel, last week, and she gave me an even stricter diet. She has ordered me to lose 30 pounds right off the bat, since being overweight is also a risk factor in recurrence. (Presumably my weight was part of the algorithm for predicting the 20% risk, so losing weight by itself--without the low-fat diet--should push my risk below the 12-16%.) In addition, eating 20-30 grams of fiber per day also lowers risk beyond the low-fat diet. So I have no idea what my new number might be, but following Rachel's orders should really cut that 20% down substantially.

And that is something I have to keep reminding myself, because the diet is draconian. It basically involves protein (fish/tofu) and lots of vegetables, with a fiber cereal thrown in for breakfast--all in pretty tiny amounts. I don't know the caloric total, but it's got to be damn low. All foods are supposed to be as close to nature as possible, virtually no processing. Nonfat substitutes are verboten because they rely on chemicals. Green tea is a prominent feature. Though many of these characteristics are quite positive, a) it's a ton of work to eat without relying on processed foods, and b) I haven't been so hungry for so long in years.

It's odd to diet because my life depends on it. I'm used to diets being about appearance. I'm constantly tempted to throw the diet out the window and just eat, dammit, like usual. It's probably no surprise that I love food and that appearance has rarely been enough of a motivator to keep me from eating what I want. (The only exception in my life was my wedding--I did diet, and successfully, for that. And then on my honeymoon I started eating everything again.) But this time, my only motivation is to be sure that, at all the 3-month and then 6-month checks awaiting me in the next 5 years, I keep hearing "all clear," every single time. It's to be sure that I don't get another tumor in the same breast, which means mastectomy next time. It's to be sure that I don't get a tumor in the other breast, which means I do this all over again, or a metastasis somewhere else, which means I will probably die of breast cancer and be on chemo until the bitter end.

None of this makes it easier to endure the yawning pit in my stomach, or to watch Noah eat sandwiches or soy dream with chocolate syrup. But it is motivating. It's enough to keep me from rationalizing "just one" indulgence, all the fifty times a day that I'm tempted to take one. And more good news--the indigestion that plagued me during chemo has all but disappeared since I started eating this way.

Still, in some ways, this diet thing has felt harder for both me and Noah than the rest of the treatments. Those had a time boundary. This--well, losing 30 pounds will take a long time (though I'm somewhere between 4 and 6 down already, which is pretty fast). And once the weight loss is over, I still have to eat ultra lowfat indefinitely. It's just one of the ways in which cancer has changed my life permanently. Of course, I could make different choices, but I choose more life (thanks, Tony Kushner). And so add this to the list of things to remind me that there was my life before cancer, and my life after diagnosis, and they are not the same, and I don't ever, ever get to go back.

Anyway, treatment goes on. We've passed the worst suffering, I think, and I'm on the watch for hair to come sprouting from my head again, and that will be a happy occurrence. But I'm not done yet--this damn disease takes lives over for a long, long time, and I'm still in its clutches.

Tuesday, August 08, 2006

Oh, happy day!

I am done with chemo!!!!

We went in today for my last treatment. Let me say that again: LAST treatment.

Of course, it couldn't be a smooth day. Just as we were headed out the door, I noticed a bunch of shredded stuff in the backyard. This is not unusual--Kibble likes nothing more than to find tissues or something similar, and to tear them to shreds. So I went to take a look. And it wasn't a tissue. It was an ant trap.

The ant trap being a product that poisons a kind of animal.

We called the vet, and the manager told us we'd better bring him right in, along with the box. So we stared at each other, as the clock ticked quickly past when we
had to leave in order to be on time. Without much idea of how to handle things, we dispatched Noah to the vet with Kibble, and I picked up the phone to call the oncology nurse and explore ways to let me drive myself home after chemo. (Usually, the benadryl dopes me up so much that it's impossible.)

Fortunately, while I was dialing, a call came in on the home phone from the vet's office. The manager had jumped the gun. Ant baits are not generally dangerous in small quantities, except that dogs can ingest bits of plastic that might obstruct the intestines. We could call the company to confirm this, keep him home, and observe him. Because my very generous friend Maia was lined up to come sit with Kibble for a few hours that day anyway, we were saved. Kibble could stay home, Maia could keep him under observation, and Noah and I could both go to chemo.

That's what happened. We left a half-hour late, which stretched a bit longer with some needed stops at the post office and bank. Once we got to USC, it was actually good. For once, we were just ushered through every step of the day without more than a 10-minute wait in between.

The blood draw was smooth, even if the receptionist teased me about
still being too scared to look at the needle. It's true--the blood-draw sticks don't hurt that much now, but I do not want to see that needle puncture my skin. Just too yuck.

I had my last appointment (for 3 months) with Christy, my oncologist, and Michelle, the fabulous oncology nurse at the breast center. We talked through my symptoms for the past two weeks (bone pain, some abdominal pain, reflux, weak skin, numb soles of feet, almost all my eyelashes gone and eyebrows rapidly following--all quite normal, she said). They provided me a referral to a radiation oncologist down here in the South Bay, so I can do my 5 days a week closer to home. There was much commiserating about Kibble's ordeal, and showing of dog pictures--with Michelle, that is; not Christy, who heard our story and immediately wondered why the heck people bother to have pets.

Thanks to our terrifically fun trip to SF this past week with Sarah and Tom, my sister- and brother-in-law, I had really exhausted myself before this chemo and seem to be getting a slight chest cold. I was worried that this might keep me from getting my last treatment today, but both Christy and Michelle reassured me--if that's the right word--that Christy is "very aggressive" and doesn't delay chemo unless the person has a raging fever or is undergoing surgery. So just a few minutes after that appointment, Lilia came to escort us to the day hospital where I get my chemo.

I was one of only three patients, so I got to pick one of the best chairs. What makes a good chemo chair? Lots of space around it; being in a corner of the room with two contiguous solid walls (not dividers, which can get bumped); a set-up that makes it easy to reach my left arm (only myleft arm can get chemo, because they removed lymph nodes on the right) and allows Noah to sit on the right side or nearby in another chemo chair (chemo chairs are comfortable recliners, whereas the guest chairs are regular, uncomfortable chairs for sitting only); and good air circulation. I think today I got the 2nd best chair in the day hospital. Nice way to go out.

We had a little hiccup with the catheter insertion. Because my hand really hurt the last time she tried to use it, Lilia had switched to my forearm. But she couldn't get the catheter into the vein, even after some poking around for it. She felt really bad--she's so nice about it, and despite this issue, she's very good at inserting IVs. We switched back to my hand, and she got it right away, so no problem.

The Taxol drip got started at around 4pm; though Lilia was off at about that time, she stayed until close to 5, chatting with me about her wedding and making sure all was OK. When it was time for her to leave, we gave her a card with a couple of gift cards for her honeymoon in January. Nothing big! We tried to stay small so as to comply with any rules about gifts for hospital personnel, but wanted to do something toward her plans, after she has done so much for me.

The drip went on without incident until about 7pm, and then the late nurse came to remove the catheter from my hand. It bled more than usual, but I didn't care. I was DONE. Noah gave me a high five as the catheter came out, and then a big hug when I stood up. My face wedged itself into a huge, immovable smile. I felt a sense of joy and hopefulness that I've felt on few occasions, such as when I got my postdoc after taking a huge gamble and turning down another, sure-thing job, or when Noah, Kody, and I finally reached the bottom of a terrifying mountain scree-pile descent in Colorado which I was not at all sure we would survive.

And what's great is, I don't even have to go back tomorrow for the Neulasta shot that boosts my white cell counts. Because we are not trying to rush my blood counts back to normal in a short, two-week window, they can take the usual 3 weeks to recover fully; plus, my blood counts have been really good all along. So I am really done with chemo. No more procedures remain. Close that chapter.

My hair will start to grow back in about 3 weeks, I will start feeling better and keep getting better after a week or two, and all my crazy symptoms like numb, blistered feet will go away. Christy says I won't be fully normal for as much as a year, but I'll see steady improvement throughout that time. I will be meeting with a nutritional oncologist on Thursday, and now that I don't have chemo to ruin my associations with any new eating habits, I plan to start eating in a way that promotes my survival, and increasing my exercise. I can cut my 20% risk of recurrence to about 16% if I take diet and exercise seriously--and I feel I must.

So next...next I have radiation, which should be a piece of cake next to this. One woman in my support group had really terrible horrific burns, but I feel confident I'll escape that, mostly because she was on chemo at the same time (very rare). With my foot blisters, I see how body skin becomes weaker, and healing is much slower during chemo. Also, she had a full mastectomy, not a lumpectomy like me, and they had to aim the beam directly at her body. She got 'sunburned' on her
back from where the radiation went through. I am hoping that the angle of radiation for me can be directed away from my torso. Well, we shall soon see. In any case, I've been told that there is fatigue associated with radiation, but it is minor compared to that from chemo--in fact, it's a function of having to go 5 days a week for 6 weeks as much as of the effects of the beam itself. And some women do not get any sunburn at all. More on radiation as it approaches. I should have my first appointment very soon, and then start treatments in about 3 weeks. If we have the schedule right, I would start on August 28 and finish on October 6. Sounds quite bearable.

After all, chemo is DONE! Did I mention that?? :-)

Sunday, July 23, 2006

"Good" cancer?

I keep meaning to write about the title of this blog. There are lots of people--lots of doctors--who will say there is no such thing as a "good" cancer. This is a terrible disease and you just really do not want to hear that diagnosis, ever. On the other hand, we can certainly differentiate between a thyroid cancer, which can often mean a bit of treatment and then you go on with your life; and liver or pancreatic cancers, which tend to mean that you will be fighting hard with aggressive treatments for a few months, after which it is possible you may not even be here anymore.

When I was diagnosed with my Stage II-A breast cancer, part of the doctor's first sentence was, "...and we're gonna cure you." That word, cure, stood out prominently. It was wonderfully reassuring, especially coupled with my longstanding sense that breast cancer was a "treat-and-go-on" diagnosis. In the past, I had taken note of famous women who had it, but always those who survived. Betty Ford. Melissa Etheridge. Olivia Newton-John. Jill Eikenberry (who was my age when diagnosed). I always felt like we heard that these women had breast cancer, and then they were treated, and then they stayed around--in many cases, for decade after decade. My own aunt had it and recovered. Because of all this, breast cancer seemed like a mild setback, and I was relatively optimistic.

But it's really all about your perspective. A woman in my support group was devastated by her diagnosis (she's close to my age, and her cancer is not much worse than mine) because she had known several women in her life who had breast cancer, and virtually all of them died. She felt she'd been given a death sentence. And indeed, the bad news starts pouring out once you are paying attention. Linda McCartney, novelist Carol Shields, Wendie Jo Sperber, and Columbian singer Soraya are only a few of the famous who recently died of their breast cancer--the latter two, quite young. I have heard plenty of stories, now, of recurrences and metastasis, and when I found that my own risk of that was 20% even after chemo, I felt a lot of my optimism grow dark.

At this point, the optimism and the darkness take turns dominating my views. But overall, I'm glad I chose this title. I very much hope that the 80% chance that I have no recurrence prevails; I am grateful that I don't have one of the far more serious and worrisome cancers that send people to the Wellness Community support groups on the same night as mine. It is awfully easy to come across information that is terrifying, and to focus on the dangers that might lie ahead. I like having the constant reminder that I once thought of this as a pretty easy thing, and that the odds tell me that, in fact, it really might be.

Sunday, July 09, 2006

Taxol Dayz

Hi folks. I'm happy to report that my relatively long silence reflects a more positive chemo experience. After finishing my 4 cycles of AC (why do they call them "cycles"? I have no idea), I was switched to a drug called a "taxane," which is another of the "big guns" that are directed against more daunting tumors, such as mine. I'm now on Taxol for 4 cycles (1 down, 3 to go--the next is on Tuesday). And I'll take Taxol over AC any day.

The bad news is, I am one of the substantial minority of people who are allergic to Taxol. I've described my reaction before so I'll spare you that again, but now I can look forward to a jumbo dose of Benadryl every time I go in for chemo. (That, coupled with the Ativan they have lined up for the increasing anxiety I feel every time, pretty much renders me a semi-conscious rag doll.) After dose 1, for the first couple of days, everything felt pretty normal. Then on Thursday, I started having aches and pains. Initially, it felt like I'd played some hard hours of volleyball for a few days; my muscles were sore and my bones felt like they'd been used as battering rams. After a while, the pain got more intense.

I just lived with it for about 24 hours, but after a very sleepless night Thursday, and several hours of strong waves of pain on Friday, I called the oncology staff. A few hours later, I downed my first Vicodin, which took the edge off but didn't bring me below the "bearable" threshold. After that, I upped the dose to two Vicodin, and that pretty much wiped out the pain. Two days of constant Vicodin (with accompanying wooziness and inability to drive), one day of sporadic half-doses, and then the pain mostly went away. With no nausea and no other major side effects (a little--very little--indigestion was the only one remaining), I actually started to feel almost normal! True, my energy is still way below par. But being on Taxol--so far--has really been so much better. Even my brain is working a bit better.

In the past week, we've celebrated the 4th of July and our 6th wedding anniversary (on the 8th). Of course, the meaning of "celebrate" is different this year. In our lives B. C. (before cancer), we would probably have gone out of town somewhere for the whole stretch, and engaged in some fun activities (hiking in Yosemite; kayaking and snorkeling at Catalina Island). At the very least, we'd both have played volleyball at the beach or some such active pursuit. Now, I don't think I could last 10 minutes playing volleyball in the sand; my half-hour walks are taxing, and if I try to do too much during a day I just get wiped out--usually in an instant, when I don't expect it.

So on the 4th we had to be contented with fireworks and dinner--not bad, really. The Redondo Beach fireworks, launched from a barge just off the pier, were so close to our house that we walked down to the edge of the marina with Kibble and watched the display over all the tethered boats. It was quite charming and uncrowded, and Kibble didn't show any fear of the explosions--in fact, he didn't seem to care at all, which was great.

I'd prepared burgers, asparagus, and goat-cheese scalloped potatoes, but when Noah went to light the grill and make the burgers, he discovered that our gas tank was empty. So we packed up the food for the next day, and went to the Manhattan Beach Brewery for a late dinner.

Yesterday, for our anniversary, we had dinner with friends Paul and Leanne, who live out in the Valley (but--lucky for them, not for us--are moving back home to British Columbia in the next few months), and Maia. Kibble got to come again, and frolic in the backyard with Paul and Leanne's golden retriever puppy, Brodie. It was a very pleasant evening, and good to spend our anniversary with other people--just as we spent our wedding day.

My mom comes out to visit on Wednesday, for a week. My dad was here just a few weeks ago, too, and a week after my mom's departure, Noah's sister Sarah and her husband Tom will be here. Through the time that remains, for chemo #6 I get a visit from mom, for chemo #7 we get a visit from Sarah and Tom (with a quick trip to SF thrown in), and then I will only have one last treatment before I am done. That light at the far end of the tunnel is getting bigger and brighter, and thanks to the Taxol I feel like I'm picking up speed.

Sunday, July 02, 2006

The meaning of life

Having cancer is like coming to a roadblock with a flashing sign that says “mortality.” Although I should get through this and be fine, nonetheless my life expectancy has taken a hit, and my chances of developing metastatic cancer have gone from less than 1% to 20%. So I have to start thinking about what I want from my life, knowing that I can’t be as comfortable as most people that I have years and years and easy years stretched out in front of me.

Let’s say that I only have 5 more years to live (who knows?). How do I want to live them? Well, two answers: I want to be sure I don’t take for granted the people in my life, and I want to be sure I can say, at the end, “I lived as fully as I could.”

It’s an awkward time to be facing this question. I’m halfway through the trek to tenure, and this is the time when most people at my stage forego having lives to invest in their careers. It’s hard to get tenure without that single-minded devotion, and I could live for another 40 years or more, and if so I will want to establish a solid career. But if I died in 5 years, and all I’d done with my time was sit in front of the computer—well, that would be fodder for regret!

What’s interesting about this, to me, is that this is the calculus that we should all engage in anyway. Having cancer has changed my odds, but it hasn’t touched the fundamental uncertainty that we all have about how long our lives will last, nor the truth that any of us could die, for any number of reasons, at any time. My tenure clock answer today—which should be the exact same answer that I gave last year—is that I will work hard, and strive, and believe that there is a future in which I’ll be well served by seeking tenure. I’ll spend a substantial amount of time working (and thank the stars that I’ve chosen work I find enriching and inherently rewarding). But I’ll also take time off, I won’t kill myself on projects I find soulless, I’ll play volleyball and go on vacations and read books for pleasure. And, with resolution #1 in mind, I’ll spend plenty of my time with people I enjoy—in the past, this was the first to go, when I had “work to do.” Now that response can’t be so knee-jerk.

Everyone faces the same conundrum, really—it’s just staring me down with a bit more intensity. To what extent do we live for the future, and to what extent do we live for today? In fact, we have to do both. It may suck to be reminded of that—but at least I have plenty of time to do something with the reminder.

Tuesday, June 27, 2006

Nurses really matter.

The nurses matter because, after the doctor writes her orders, they are sent over to nurses who actually do everything. The nurse assigned to you for the day will be the one to find a vein, to stick a catheter into that vein, to sit and push toxic chemicals through the catheter into the vein, to check on you to be sure your arm is not swelling or reddening and your face isn't flushing. She'll talk to you and comfort you and explain all the side effects and then, later, take out the catheter and wrap up your hand so it doesn't bleed, and send you home.

The good ones get the needle stick on the first try.
The bad ones moan about your inconvenient veins and muddle around a bit under your skin...with a sharp object.

The good ones know that all the fluids, both hazardous and harmless, can hurt going in. So they set saline drips to be relatively slow, and sit with you to push ver-r-r-r-r-ry slowly, by hand, anything that is a real problem.
The bad ones have somewhere else to be, and just shove that plunger down quickly.

The good ones think about how your arm should be placed on its pillow, how the lines are draped (to stay out of our way); they place their warm hands, for heat, on your forearm when the chemicals are stinging.
The bad ones figure you can do all that yourself.

The good ones remember, week to week, that you are afraid of needles and don't like to watch that catheter being inserted. They remember that you don't want a warning, thanks--just stick it in while you look at the opposite wall. They notice when your anxiety is getting worse each time, and making your stomach upset for no other reason, and they recommend Atavan to help out, and then contact the oncology staff to get it prescribed. And then they give you a whole pill.
The bad ones don't notice any of this stuff, although they'll let you look away during the needle sticks.

The good ones stand there with nothing else to do, really, for 15 minutes to watch you and ask you questions when you get a new drug. Do you feel funny? Any changes? When you report that yes, on this new drug Taxol you are experiencing a tightening in your chest (harder to breathe) and these bizarre, spasmodic, pulsing pains in your lower back, she runs to the pharmacy and bangs on the window to get your Benadryl, and then slowly, slowly, pushes it into the saline drip (having turned off the Taxol for a while) and soothes you as the symptoms subside. She lingers more, waits to be sure you feel okay. When she restarts the Taxol (because that's what they do--no one is deterred by a little allergic reaction), she watches carefully again, asks all the questions, smiles at how groggy you're getting thanks to Atavan and a huge dose of IV Benadryl, doesn't leave until you have taken in 25cc's and it's clear you'll be OK this time.

The good ones are off shortly after 4, but say they can stay until 5 today (since your allergy problems didn't even resolve until after 4:15) so they can keep checking. They make sure to hand off smoothly to the nurse who will stay late, until almost 8pm, since your drip is 3 hours long and has to go slowly at first.

The good ones smile and laugh, tell you funny stories about movies they went to and happy stories about their upcomming weddings. They answer all questions with confidence. They have their share of complaints about the hospital's current bureaucratic admin changes, but they focus on the positive: "Change is always hard; we'll just learn it and we'll be fine." They tell stories of their own families' cancer histories, or their own; they talk about their years of experience giving chemotherapy, and why they do it, and the best ones have pet peeves that involve shirking on quality patient care, so you know you're in good hands.

Today's nurse, Lilia, who is the best nurse and whom I request, now (having learned my lesson), every time--told another story of a patient who was rude to her, who dropped her newspaper and told the doctor, as he bent to pick it up, "Don't worry--the girl will get it." She meant Lilia, who heard it and got all her ire raised. What a fool was this woman. She is still coming in to USC, and now the very best oncology nurse there--the one who can make sure you don't hurt, when let me tell you, other nurses make you hurt--doesn't like her. What a stupid and avoidable mistake.

The nurses make all the difference. Lilia stands between me and repeated pain. I feel so lucky to have found her (on my first day of chemo!) and so smart to continue requesting her. I hope she is paid extremely well, and I'm sure she's not. But she'll be able to look back on her life, and say honestly and deservedly, "I lived well, I did something important, I made a difference."

Sunday, June 18, 2006

Aloxi is my friend

It's not like I've felt as "good" as in the first two cycles, but we've managed to avoid the horror of the third cycle, and I'm sure it's thanks to Aloxi, the new anti-nausea drug. Well, that and the acu-stimulant wristband that Rick and Joanie sent me (thanks, guys!!), which got me through a couple of days when I think I'd have had the nausea otherwise.

Supposedly, I get to actually get better now--I'm done with AC, and the Taxol is not supposed to cause nausea. So I am looking forward to a positive trajectory. It's amazing how much hope that provides.

Wednesday, June 14, 2006

Finished with AC!

Well, I am halfway done with chemo.


I had my last AC treatment yesterday, and since the next drug (Taxol) is not supposed to cause nausea, it is really a positive to make this transition. Not to mention that the number of remaining treatments will become smaller than the number completed--definitely good for the psyche.

When I reported on my tough experience last time, my oncologist decided to switch my pre-chemo anti-nausea drip to a new one called Aloxie (sp??). So far, that one seems to be working pretty well. Of course, it usually takes a day or two for misery to kick in, but I'm in less need of my nausea pills this time. Crossing fingers.

But seriously...halfway done. Finished with AC. Those are happy things.

Thursday, June 08, 2006

Feeling better

Just a quick note to say that finally, a week after chemo, I feel a bit better. Was able to leave the house for short jaunts on Monday and Tuesday; today I even went to school, to pick up some stuff at the office. That has become a noteworthy event! We got some new lounge chairs, so I can sit outside on a nice day (slathered in sunscreen, of course--chemo causes sun sensitivity). And as of Monday, I can eat with some normalcy again, too.

Over the weekend, my eating was really weird. One day, I could hardly stand drinking anything. I sent Noah to the store for apples and watermelon, then juiced the apples and made watermelon agua fresca. Those, I could drink. On Sunday, I couldn't manage to eat anything, but suddenly thought I might be able to stomach some potato salad. So Noah's off to Vons again (he is making lots of trips there--good thing it's only a few blocks away) and I managed about 1/3 of a package of that. It's quite an interesting diet. I usually love tropical iced tea, and now can barely stand the smell of it (or garlic--though that flavor is fine). All kinds of weird quirks.

Anyway, I have had enough energy since Monday to resume more normal activity, and each day has been a little better. Thank goodness next week is the last AC. At least I won't have the nausea to worry about after that. Meanwhile, I am enjoying being able to use my brain and my body for the next 5 days.

Sunday, June 04, 2006

All in my head

Devil: This time around has sucked. Sucked. It's Sunday and I still feel "not right"--yesterday was so bad that I could barely move off the couch and couldn't take my daily walk. There's some nausea (for which, stupidly, I forgot to take any pills until Noah reminded me at night of that possibility--and the pill helped). There's major fatigue--on my Friday walk, I felt exhausted about 2 minutes before I got back home, and just never bounced back from that. The Neulasta causes bone aches, and sitting on the couch--about all I can do--leads to aches and discomfort. Overall, it's just very not right.

Angel: But really, it's still not as bad as one might expect. I'm not throwing up. I'm not literally unable to get out of bed. As bad as I ever feel, I keep thinking I'm just overblowing it (I've always been a wimp about even the most minor illness). It's probably a whole lot worse for other people.

Devil: It's boring, frustrating, even depressing to have to sit around and not be able to do anything. Noah tries to cheer me up, encourage me to get out and do things...I pushed myself hard to walk two days, but then just couldn't do it. I don't want to talk, so there's not much he can do for me. My eyes hurt, so reading is tough and even TV gets difficult. It's hard to find a sitting position that keeps my stomach calm. I want to think, to write, to work, to read, to move, to be active--to do anything.

Angel: Once Noah realized that I couldn't go out for diversion, he really stepped up to bring diversion to me. He's made lots of little trips to the store, has played Battleship with me (no eye strain, no energy needed), tells me stories when I want them and is quiet when I want that.

Devil: Just thinking of chemo now makes me feel physically ill. If I picture the IV, or the day hospital, or any aspect of it (including writing this), my stomach lurches and I feel horrible. It's starting to make the thought of going become dreadful--literally. This is a more difficult challenge to my self-discipline than I've maybe ever faced. It's not that the experience itself is so bad, but the thought of it is becoming terrible. It really is so much in my head.

Angel: The chemo is giving me a 23% better chance (in absolute terms) of avoiding any recurrence of the cancer for 10 years. If it's working, it's killing off any dangerous little cells that are still left. If I can focus on my breathing, I can keep from plunging into the darker thoughts of chemo, and keep those ill feelings at bay.

Devil: At the start of chemo, I felt great. Perfectly healthy. The tumor had been removed, my mobility was pretty much back, and I felt really normal. Now I feel like a Sick Person. I'm sedentary and limited and yucky-feeling, and (since I haven't really announced this yet) I have basically no hair. I have days of feeling better and almost normal, but even on my best days now I get more tired, sleep a lot more, feel I can do less. Before starting chemo, I read a piece by a woman just finishing hers, and she said she gazed in the mirror with an old picture in her hand--herself with hair, smiling and healthy--and wondered who she was. That seemed so remote--even in my darkest days, I thought, I'll remember who I am. But who I am today is such a shell.

Angel: And yet I do remember this always: I am not really sick. I'm being given drugs that make me feel lousy, but these are just drug side effects. And the drugs are prophylactic: they are not treating a current illness (the tumor is gone!) but are the sacrifice I am making for four months in hopes that I have years and years and years in which I don't have to worry about this anymore. If someone could tell me for sure, in three years you would be dealing with a recurrence, but if you choose to go through this now, it won't happen--then absolutely, I would choose this. And I have chosen this, even without the certain forecast. It is really hard. But I chose it for a reason. So I'll stick with it, and I'll make it through.

Thursday, June 01, 2006

It's been a while

Hello folks.

I'm pleased to say that one reason for my silence this past week was that I got to have some fun. Noah and I went up to Oakland for his brother Sam's "wedding" (we're not supposed to say that, but it's still the best descriptor). We flew up on Thursday and stayed until Tuesday. We made it to a couple of favorite SF restaurants (and a couple of others in the East Bay), and though almost all of our time was spent in family events, we got to see a bit of our old stomping grounds. The visit was fun anyway, and I enjoyed seeing the whole large, loud, loose, loving Markewich clan.

We flew back on Tuesday just in time for chemo. I did not want to go. In fact, I was writing a blog entry in my head the night before, and it went like this:

No, no, no, no. Don't make me go. I don't want to, I don't want to.
This just better f***king be working.

Nice, huh? But quite true to my state of mind. The physical side effects, as it turns out, are not so bad for me--but mentally it is really rough. Just knowing that there are these toxic fluids being put into me, and that I'll feel even a little bad, is difficult. At this point in the cycle, I feel rotten just because of the thought of chemo, even more than from the chemo itself.

At least I have only one more AC treatment (that is the one that causes nausea) and then I'm on to Taxol, which has its own problems--but they do not include nausea, and somehow that seems worse than the others to me. I don't like feeling nauseated, and I associate nausea with mental stress, so it's even worse. And after the next treatment I'll be halfway done, so that's a positive too.

Meanwhile, I actually feel a little better this time than last. I have been more vigilant about taking the anti-nausea drugs, which seems to be helping, and I have a little more energy. Usually Thursdays after chemo mean I lie on the couch all day, but today I made some food and went on a walk--both real accomplishments!--and even got some work done, which was also nice.

But having done all that--I'm a little tired now. It's a lovely afternoon here, on a day that's been in the mid-70s, and Noah's about to go to volleyball. I think I'll relax and stop typing. More later.

Sunday, May 21, 2006


This experience has made me a whole lot more interested in Terror Management Theory. This is a psychological theory that argues that humans are motivated by a fundamental existential anxiety--basically, the fear of death. And all sorts of processes, both good and bad, might reflect the influence of this fear. So, we strive for higher self-esteem as a buffer against death; we denigrate other groups of people as a buffer against death; we seek status as a buffer against death.

In the first days after my diagnosis, I would tell you that I wasn't thinking I would die. But I was hard-core into terror management anyway. My identity became really important to me--when I'd go into the doctors' offices, I'd want to be dressed for work, and I preferred reading journal articles to more mindless, comforting fare. I'd want to be dealt with as a professor, not just as a patient. It made me feel more protected, in some ways; it made me feel less helpless. And I really think that it was fundamentally an existential concern. Just as, throughout life, we accumulate possessions and positions that seem to cocoon us from danger, in my early days of grappling with a new, unwanted identity as "cancer patient," I clung to the trappings of strength and status.

And in more recent days? Well, I can't say that the desire to be seen as "professor" over "patient" has lessened, but when I go to the hospital for treatment, my priorities are comfort and distraction. I dress in my most comfortable sweats, bring along DVDs of kids' movies (Harry Potter--thanks, Alison!, Ice Age, Finding Nemo, The Incredibles), and eat popsicles. It's not that I'm any happier with the identity I didn't ask for, but having poisons pumped through a needle into my veins has pushed me closer to the raw state of existence. Many of the terror managing strategies have dropped away.

Am I less concerned with self esteem, less likely to derogate other groups? Well, I'm not sure about that--I worry about my (fake) hair looking good and I still resent Republicans. On the other hand, I just can't care too much about comparing my appearance or accomplishments to others' right now, and though gossip is a fun distraction, some kinds of derision just seem too trivial to bother.

The fact of mortality has become much more salient, even though I do think I'll be cured. And with that fact comes an awareness of the laughability of our little efforts to be Safe. I think all of American society is designed to make us feel invulnerable (think gated communities, Hummers, resistance to oil conservation...hell, boob jobs and Sephora), and we've evolved a psychology to match. But something like this reminds you that all the protections meant nothing. Ultimately, none of us will be Safe. Money and status are ways of distancing ourselves from that fact, but (so far, at least) even these buffers haven't proved effective in the end.

Saturday, May 20, 2006

Hair obsession

Really, this is just the most traumatic part of the whole thing in a sense, so forgive my fixation on every minute progression in the hair process. Here's the buzz cut we gave me yesterday. I still have this much--it's hanging on pretty well, though I wore a scarf to the beach today and the wig to dinner with friends. Anyway--more butchy than I would choose for myself, but not as bad as I'd feared. Yet.

Friday, May 19, 2006

It kinda hurts coming out

Remember a time when you've had a really bad sunburn on the top of your head. If you don't have thin hair, like mine, you may have lucked out of this experience. But if you've had it, then remember what it was like to pull a comb through your hair--how every little strand tugged at your burned, achy scalp, and you got a whole chorus of complaint when you tried to shift locks from one side to another. Remember that? That's what it feels like when chemo kills your follicles, and some of the hair is giving up and throwing itself overboard, and the rest is hanging on with nails dug in, refusing to go yet. Maybe it helps to ease things a bit--it'll be a relief when my hair isn't so painful anymore.

Shit hits fan

So yes, maybe I'm one of the lucky ones, but that apparently doesn't translate to a "get out of jail free" card throughout chemotherapy.

Yesterday at dawn I woke up from a very pleasant sleep, toddled to the bathroom, climbed back in bed--and was hit by a wave of nausea that threatened to send me running back to said bathroom with great urgency. I sat up, and my stomach settled a bit, but clearly I wasn't going to be able to go back to that pleasant sleep.

After popping a nausea pill, I went downstairs to the couch, where I could prop myself into a seated position and go to sleep. That worked for the next several hours, actually, punctuated by a trip to the medicine cabinet for the backup nausea pill, called for when the first one can't do the job alone. Noah came downstairs in the AM and I "got up," which means I began hanging out on the couch awake for the day. And that's pretty much all I did--watched TV, played on the computer, read mindless things, and sat there mostly-upright, vigilantly attending to my vestibular system, taking pills as soon as the required 4 or 6 hours had passed, and trying not to feel too lousy. In fact, I never had to pray to the porcelain gods, so I still think this was milder than it could have been. But I felt like crap all day. By nighttime, the nausea was under control and I went to sleep in bed again. And slept all night--aaahhhh. Today the tum is OK again.

But then there's issue #2. On Wednesday, when I washed and brushed my hair, the usual few strands that come out in fingers and brush had noticeably multiplied. It was pretty clear that The Hair Loss had begun. But the loss rate was small enough that I did nothing. Yesterday, the hair was coming out more seriously, but still not so much that it seemed time to shave it. I didn't wash it (yuck, I know) and stuck it in a ponytail, so that any loosening hairs would be caught by the band.

Today I got in the shower and wet my hair, and when I pulled my fingers through, I came up with something well beyond "strands" of hair--something approaching a "lock" of hair. Argh. After the shower (still didn't wash it--that would have been like a massacre, I think), I put all my hair in a ponytail and Noah helped me cut the ponytail off. Then he straightened all the ends for me. Now I am sitting here with about ear-length hair, feeling it dry and lift from my scalp, feeling little strands blow softly. It's a very pleasant feeling. I'm trying to soak it all up, because I suspect that by the end of today--at very latest, tomorrow--we will have to pull out the razor and buzz it all off. That will be depressing. It's already a little sad.

The consequences of the cure--I dodge them a bit, but ultimately I have to face them. And the last couple of days, I've had to face a little more.

Tuesday, May 16, 2006

Chemo 2

I'm lying on the couch with the laptop. Chemo was fine today. Blood test first--all my counts were well within normal, and even pretty close to my counts from several weeks ago before any chemo was given. Only noteworthy thing: very long wait. Noah finally had to get up to check, and was told that they had called us a half hour earlier (though neither of us recalls hearing or seeing anyone--oh, well.)

Oh, and a second noteworthy thing was that Noah went out just before my adriamycin drip to try to find me popsicles. We keep trying to bring popsicles, because we've read that eating them during adriamycin helps to prevent mouth sores. Last time, they were total mush by the time I got them out. This time, we tried a much more aggressive freezing system, but had the same problem. So he went out to the little campus convenience store, and finding none, he took a walk pretty far from the hospital, until finally he found a place with really good Mexican ices. He made it back in time for the 2nd half of the drip, and I had a lime and a coconut. Mmmm.

We got home around 6pm after picking Kibble up from doggy daycare, and we went to a low-key restaurant for a meal, and now we're back home. I'm wiped out, though it may have nothing to do with the chemo--I worked really hard this weekend and yesterday (built Kibble a sandbox and did a lot of gardening, plus some actual school-related work) and probably just pushed too hard. Anyway, I think I'll watch Jon Stewart and Stephen Colbert, and then go to sleep. But again, I'm doing OK. My hair is still attached (oncologist and chemo nurse both warned me today that it faces an imminent demise). No nausea. I'm one of the lucky ones.


Saturday, May 13, 2006

Acupuncture hurts like HELL

...when there's a lot of toxic crap in your body. Just thought you'd like to know.

Hair Watch 2006

My hair is still hanging on.

The oncologist and her nurse both told me that I should expect the mass fall-out some time around a week and a half after the first chemo. Well, the first chemo was a week and four days ago, so I think we are right there. Some women in a support group said theirs stayed put for about three weeks, and I found a blog by a woman whose hair started coming out after two weeks and two days.

So it could literally be any day now.

About four days after chemo, I did start noticing that my hair was looking limp and dull. It's really dark and lifeless--no shine or glow at this point. Like the light is absorbed and can't get out. It hasn't really gotten worse since then, but I feel like it's just dying in place.

And in the past couple of days, my scalp has started tingling and burning in a new and unfamiliar way. I have read that the hair loss is associated with this kind of tingling and burning.

This is definitely one of the scariest and most distressing steps in the whole "process." I am really not looking forward to it. But I am at least prepared. I have a wig, a couple of turban-y hats (the Cancer Patient Look), some soft caps (one is pictured above--thanks Mom!), and a bunch of nice and funky scarves that were sent to me by the friend of one of my MBA students who just finished her own treatment.

From what we've heard, you know when the hair is going. You might run your fingers through it, and you come away with a handful. Or you see a clump lying on the pillow. Or you brush along the top of your head, and suddenly there's a reverse Mohawk. The standard advice is, once the first clump goes, shave it all off. Not just GI Jane, either--more like Captain Picard. So that's the plan. It will be painful, no doubt--especially since, with 10 days under my belt since getting chemo, it seems like surely I could have chemo and keep my hair.

Yeah, I know better. Every time Noah or I touch my hair, there's a moment of suspense: will it still be attached? So far, the answer's been yes. But not for much longer.

Wednesday, May 10, 2006


...have been enabled. Please feel free to talk back!

The cancer care schedule

I'm applying for a year's extension on my tenure clock. That's been recommended to me many times over, and though I get a lot of psychological comfort and benefit from working on research projects right now (hey, I can write on a laptop while lying on the couch!), it does seem like my productivity will be taking a hit.

Here's what it takes just in terms of formal appointments to handle cancer. I'm giving my schedule in a 2-week block based on chemo treatments. So the first day is always a Tuesday, if you care. And this assumes nothing goes wrong and I never have to go in for anything else.

Day 1: Chemo (all day at USC-Norris Cancer Hospital)
Day 2: Back to Norris for Neulasta shot in my stomach
The Wellness Community (TWC) Support Group
Day 4: Physical therapy at Cedars-Sinai (post-operative)
Day 8: Acupuncture
TWC Support Group
Day 10: Physical therapy

Driving times:
Norris - 45 minutes to 1.5 hours, depending on traffic
Cedars-Sinai - 35 minutes to 1.25 hours
Acupuncture - 15 minutes
TWC - 15 minutes

Up to now, there have also been extra appointments for looking at wigs, buying the wig, having the wig styled, going to my landlady's support group, going to a TWC intake meeting, etc. Fortunately, these drop off now and I can plan on the above. It is really nice when I have a few days in a row with no cancer-related appointments! Meetings at school never looked so good.

Then, day to day, there are various things I'm supposed to be sure to do, to promote health and healing and to combat side effects. These are:
  • get up by about 10-11am (I know, play me a violin)
  • take Chinese herbs 3x a day (for side effects)
  • take expensive drugs 3x a day (only just after chemo)
  • go on at least a 1/2-hour walk
  • do my series of post-surgery arm stretches
  • every other day, do a set of hip and leg strengtheners (these areas get weak during chemo, and can be in pain due to Neulasta)
  • get to bed by 11:30-12
These are a lot of things that demand a share of my time and attention, that are not necessarily how I want to spend all that time and attention. Of course, they are also all health-promoting things, and in some ways it is very nice--almost a luxury--to be "forced" to tune in to taking care of myself, and doing things that put my body and life first.

Still, these are not the activities that tenure rewards. So year extension, here I come.

Monday, May 08, 2006

What chemo is like

Does anyone want to know this? Well, here goes.

The battle analogy story told most of it, but to be more specific: Going to chemo will start (after day 1, when it wasn't necessary) with a blood test, to be sure my white & red blood cells and platelets have recovered from the last time, so that chemo won't really hurt me. I'll have to wait around for at least 45 minutes until they call me to the day hospital. Given that I waited over an hour on the first day, with no blood test, I suspect this wait may be much longer.

I go into the day hospital and am seated in a pretty comfortable recliner chair. The nurse gives me anti-nausea meds (pills) and starts the IV. Saline flows for a while. Once my system is sufficiently bolstered against nausea, the nurse comes back with a pink bag of fluid and a needle, and pushes Adriamycin into the IV for about 1/2 hour. Then she hooks up a clear bag of fluid to the IV and turns on a machine that regulates its delivery, and that flows for the next hour. And then I get disconnected and leave.

After the first treatment, I felt fine for more than 24 hours. A little odd at times, but basically normal and energetic. We went out to dinner that night (of course) and I ate normally. The next day, I had a very full schedule, and all day I just felt fine. Then, at about 10pm, I crashed. Hard. It was like pulling the plug from a bathtub full of water--the water all rushes out and there is nothing left. I had my head on my arm at the dining room table, and went up to bed pretty much right away.

Then, for several days, I was tired and sluggish, and my stomach was finicky. Whether we ate out or at home, I might think I was going to eat item A, and then a few minutes later the thought of A was just horrible. I chose menu items that I never choose, and bypassed my favorites. I would find something I could eat and chow down ravenously, and then--midbite--my stomach would announce that it was done now, thank you very much, and I had to stop. Or else.

I've heard a "good response" to chemo described as something like a bad hangover. This strikes me as just right, though I don't have a ton of hangover experience. But the general sluggishness, a tiny headache sometimes, a low tolerance for minor annoyances, and more than anything that finicky stomach--those are just what my bad hangovers have been in the past. I can live with it. It's not exactly pleasant, though. And in the interests of full disclosure--Noah claims that the aforementioned "low tolerance" is actually a very short fuse and that I'm temperamentally quite difficult. I, of course, disagree.

Anyway, as of two days ago, my tummy got a lot more easygoing (more food, more variety, less weirdness in selection) and my energy went way up again. Week 2 started yesterday (that is, no chemo) and so maybe I feel better in the second week. At the same time, my body is fighting hard to get rid of all the toxic junk right now, and it won't get to finish the job by next Tuesday, and then more will be put in. One step forward, two steps back. This is why they say the effects cumulate--I'll feel worst at about weeks 6-10, when the current drug mix (AC) is at its highest dosage. Great, something to look forward to.

Tuesday, May 02, 2006

First dispatch from the front

Reveille at 9am. Out of the bunk, a hot shower, the most comfortable fatigues, a quick chow in the mess to ensure a full stomach. A full stomach is the first piece of ammunition. Also, much drinking. Filled the canteen and drained it several times over throughout the day. Fluids are the second piece of ammunition. Both pieces, check.

We drove the humvee to the battle zone. Dropped off the K-9 at the safehouse on our way out. It was a slog through the heavy traffic of a hazy LA morning.

Arrived at the zone around 11:15am. Checked in with the sergeant on duty and sat in the staging area, surrounded by our gear. DVD player, check. Cooler with popsicles, check. Blanket, check. Reading material, check. The minutes dragged on. Dread became palpable.

This is the kind of moment when some soldiers might go AWOL. Might cut and run. But there was a battle to be fought. We pulled out more ammunition: Seinfeld DVDs. Watched two episodes of Season 3. Nothing heavy, just a little doobie for the FNGs.

After about an hour, a captain arrived to escort us to the front. Better than expected. Instead of lining up the ranks row-by-row, the strategy was to give each troop their own territory, where they could do combat one-on-one. This soldier had a recliner, and her backup man had a regular padded wood chair. A bit better than the muddy trenches, indeed. The fight started quickly. Four bullets were fired against the Nausea forces. Then the only blood-producing casualty of the day: one quick volley, and the first line of attack was opened. Pretty soon, our forces were pouring through the vein to seek out and destroy the insurgent cells.

The captain commanded the first half-hour personally, keeping up a steady barrage of fire. She used the Adriamycin arsenal, feeding the red ammunition at an even pace. This was where I was supposed to use my popsicle protective gear, but it had melted in the searing heat. Oh well. The captain kindly provided crushed ice and more iced tea for me. Not quite Kevlar, but hopefully it'll prevent Cancer War Syndrome in the days to come.

After the Adriamycin barrage, the captain set up an automatic artillery, firing Cytoxan at the enemy for the next hour. Throughout, I made my own salvos--working the "high spirits" battle by watching Ice Age and Battlestar Galactica. Pleased to report that I didn't bug out or desert. And no major casualties. Some sinus pain and a bit of a headache--not much to complain of, given the big guns that were firing wildly all around me.

That was the end. Fire died down right away once the last barrage ended. The whole time, there was not a peep from the enemy. Suckahs!! You'd think Saddam Hussein had trained their army.

And I walked away without so much as my arm in a sling. A bandage around my hand, where the first volley nicked me. Pleased to report no other wounds. So far, we've retired to the mess and enjoyed some pretty good chow. All regions reporting in "calm," no insurgent activity. The all-important midsection is quiet. It's under curfew, and the citizenry appear to be sleeping calmly (when not, they are cooperating with our forces). The northernmost region reports a few transition pains, but nothing that our specially-trained Advil Platoon can't manage. And we even patrolled the perimeter with no lagging or malingering.

All in all, the first day of engagement went fine. Will report on injuries, if needed, in the coming days. Tomorrow, another artillery barrage at 11am (the Neulasta stocks) will get sent out to form a protective barrier around the White Blood Cell division. And then in the afternoon, we bring out the special "acu" division that will shore up all defenses, including armor and protective gear.

Next major engagement in 2 weeks. Over and out.