Lucky

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.

Signs

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.

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.

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.

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:

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.

Grumbles

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.

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.

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!

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.

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.

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.

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?? :-)