Christmas time is here...

...and my present is a week off from chemo. Well, it isn't really a present that was given to me. I'm taking a little time off from chemo and from work over the Christmas holiday to visit friends and family. It's been a hectic week trying to get everything done - last minute shopping, end of year projects at work, end of year bookkeeping for taxes (ugh). I'll be ready to kick back and relax a little, catch up on reading, catch up on long overdue correspondence (including Christmas cards which will end up arriving after the holiday - sorry about that), and SLEEP. The sleep part sounds pretty good right now.

I had to include the Christmas PET scan this week.

And I offer no explanation for the last picture other than some holiday silliness. I hope that you all have a Merry Christmas.

Happy Holidays

Thanks to my good buddy Angela for stopping by after her radiation treatment on Thursday to bring decorations for my IV tree - garlands and candy canes hung with my meds all day - a cancer Christmas tree. And I do mean all day - it was a long one. My chemo port was clogged, so we had take some extra time with the "rattlesnake venom" treatment to clear the clog in the catheter - all in all, about a 9-hour stay. But as bad as that sounds, it really isn't. I have lots of friends there and we drag our IV trees around the treatment center and visit each other all day - a kind of cancer block party. I don't know if this is something that happens on days when I'm not there, but I'm glad they let us get away with it. We learn a lot from each other and generally create a pretty good vibe in a place that might not ordinarily have one. As bad as cancer is, one of the gifts it brings is being with these people - the patients, nurses and doctors - they're all just the best.

This week by the numbers - marker up slightly at 7.2. I should try to see if I can animate a stock ticker on the side to display the tumor marker numbers. I used to keep a spreadsheet with a running graphical display, but lost track of it - buried in a distant subdirectory.

I am running a belated Hanukkah picture - last Wednesday was the last day, but I thought I'd include it as this week's postscript:

The menorah is a little hard to make out in the image. Sorry about that.

I know you...but who are you again...?

How many times have you had that awkward moment - you meet someone that you haven't seen for some time, and for some reason, you just can't remember their name. For cancer patients undergoing chemotherapy, this happens more than we'd like to admit. It used to sort of a patient's joke about having "chemobrain" as a way to explain a little forgetfulness, but studies done in the past few years have documented effects of chemotherapy on the frontal cortex of the brain. There isn't a lot of data on this - the few studies out there have been done with breast cancer patients - they tend to live longer and hence are a better study population than patients with other forms of cancer. It's not clear which part of the overall regimen is responsible for the interference with the frontal cortex - it could be any of a number of things that have managed to cross the blood/brain interface. It could be the cytotoxic chemo drugs that kill actively growing cells; it could be the steroids or other meds given to minimize the side effects; it could be from a combination of these and other drugs administered. For women, it may also be an interaction between hormone changes with menopause interacting with the drugs as well. For patients with extreme fatigue, it may be confounded with altered sleeping patterns. Whatever the precise reason(s), it can mean problems with learning new tasks, performing multiple tasks simultaneously and short term memory loss. The good news is that there is at least one study that indicates that this condition may be reversible to some exent when treatment is completed. I hope they're right.

I'm sure that chemo has probably affected me to some extent. I find myself struggling sometimes at work and in social situations to come up with names of people that I don't interact with on a regular basis or sometimes with people I've recently been introduced to. I probably owe an apology or two out there when I've failed to make proper introductions, but I just drew a blank with your first name, or last name or both. If you give me a minute, you might be able to imagine my short-circuited brain trying to feverishly reconstruct our relationship in the convoluted manner that helps me figure it out:

• I worked with you or someone in your work group on a certain project that triggers a series of relationships that associate you with perhaps as many as three or four people before I figure it out again. I know you from church because your child was in a Sunday school class that my daughter helps out in or that my wife had you volunteer to be a Sunday school teacher, so I try to associate you through a relative.
• You used to ride on my vanpool, so I sneak a peak an old email or ridership report (I still do the bookkeeping on my vanpool, so I have records that go back for a long time).
• Old saved email works great for tracing old threads of conversations that help remember your name.
• I should send a Christmas card to the folks at Google - they've saved my butt a few times.
• I write down lot more things in my desk journal at work.
• I try to put reminders on my schedule to make sure I don't forget things.
• I make checklists.
• I try to keep my brain working constantly - I may not be physically as able I used to be, I can't afford to lose the brain too because I won't get by on my good looks (you've already heard my whine about the various attractive rashes from the Erbitux).

They all help, along with a healthy dose of fear that I'll drop the ball on something or someone important. I hope that people will understand - I don't want to use it as a blanket excuse for not pulling my share of work and responsibility, but sometimes it takes me just a little longer. Thanks for your patience.

Planning

Sorry I'm a little behind in posting this week - I needed to recharge and catch up on some sleep this weekend. This is pretty typical after a treatment session, and the sequence goes something like this: Get treatment on Thursday (an all-day undertaking), come home a little groggy (mostly from the pre-med drugs intended to alleviate nausea), eat dinner, get ready for bed (lots of steps here - more on that another time). Sleep for about an hour, and then remain awake until about 5:30 or so - the steroids (decadron) I get for preventing nausea tend to make my mind race about randomly but not particularly in a useful manner. I'm finally so exhausted that I fall asleep for a few hours on Friday morning before waking and going in to work. Why bother going in to work at all, you ask? Because that's what I do - I may not feel great, but I actually do get some satisfaction in getting work done, and the decadron does provide enough of a lift to let you physically and mentally do some amazing things. I repaired my roof last year after a windstorm blew a lot of shingles off on a treatment Thursday - something I might not have had the endurance to do without the decadron. I can usually sleep on Friday night - I'm pretty exhausted from lack of sleep, but sometimes the decadron keeps me awake on Friday night as well, and I'm so tired by Saturday morning that I crash and may sleep until I have to go back to the treatment center to get Silent Bob disconnected. The picture above shows me napping, with Silent Bob in the little black case. I may fall asleep again after leaving the treatment center and nap some more on Saturday and into Sunday. I may get a few things done on Sunday, but may also take a nap again. Eventually, I may snap out of the hibernation, but it may take a few days.

I've been taking a little time over the past day and a half to take in a retirement planning seminar at work, with the final session all day tomorrow. For any of you who have this sort of thing available from your employer, I highly recommend it. It's better to take some time to plan ahead well before retirement than to wait until the last minute. It's been a little strange for me to hear that the average life expectancy now may well be up into the age of the high 80's and early 90's, and that you may need to plan on having enough money saved up to support your lifestyle for another 40 or 50 years as a retiree. But I'm probably in a little different place in life than the rest of the class. While none of us can forecast the future and know how long we have to live, I have a pretty good idea what will do me in, and that there's a very good chance that I won't live to be an old man. Living to age 80 or 90 is probably not going happen. This doesn't make trying to plan your future financial resources any easier though. I need to make sure that my health care needs are covered - they're not likely to go away anytime soon, and they won't be cheap. I need to make sure that my loved ones have enough to survive and prosper after I'm gone. It may sound morbid, but there's the basic fact that treatment is buying me time. If I'm fortunate, it will buy time measured in years. But what if....? What if I'm really lucky and beat the odds for long term survival? What if I really do get into that elite club and survive longer than 5 years (statistically that's only 6-10% of us when the clinical trials were done a few years ago)? How do I plan for something that is kind of statistical long shot? There's a chance I may be able to participate in a new clinical trial in a few months - what if it works really well? Of course, that would be wonderful, but how can you plan with so many unknown variables? Well, the fact is that even for healthy people, the future is still unknown, so I really shouldn't fret. It's going to be challenging to fine-tune a long term financial plan, but at least I feel like I've learned a few things and will be better prepared. And I still like to think that statistical long shots are a good thing to hope for.

For the record books, last Thursday's marker numbers went down again - last measured at 8.6 and now down to 6.2.














Snow in my backyard on Saturday morning

A Happy Thanksgiving

I enjoy cooking. Thanksgiving gives me a chance to play in the kitchen, and this year to extend playtime a few more days with some fresh shellfish. Sure, the turkey was pretty good this year (thanks to my brother Mike for the smoked turkey tips), but the lure of fresh oysters and clams makes even good leftover turkey take a back seat.

We spent Friday afternoon and evening with our friends, the Whites, digging razor clams down on the Washington coast. We didn't all catch our limits but my daughter Meredith (shown in picture) came close, and now has the title "clam whisperer". I'm a little off my game - the chemo has sapped my endurance and I get winded pretty easily, but I can't use that as an excuse for not making a limit - I just didn't see anything that looked like a clam this time out. So the student has now become the master. I did manage to catch a few, and insisted on photographic evidence, shown below as Exhibit B. That rosey glow and bright red honker is not my attempt to play Rudolph the Red-Nosed clam digger - yeah it's this week's latest set of side-effects (more later).

Exhibit B

Earlier in the day, I went up to Seattle with the Whites. While Susan watched their daughter march in the Thanksgiving parade, Tim and I hit Pike Place to track down a sampling of Pacific coast oysters (as promised in last week's post). The selection was limited to two varieties this time around, but that just means that we'll get to go back and try the rest later when they're more readily available. Tim is shown here picking out a dozen choice Kumamoto oysters.

Also available this time around were some nice Pacific oysters shown below before we slurped them down.








Our verdict? We liked the Kumamotos a lot - an unusually sort of creamy texture and almost a little on the sweet side - we'd definitely have them again. The Pacifics were a completely different taste - very briny, perhaps more than we had expected. We go camping every year with the Whites (and a bunch of other folks -many are fellow NC Staters) and dig clams and oysters. We're used to a different kind of oysters - Quilcenes and whatever the monster oysters are at Duckabush Flats on Hood Canal. Now that we've tried a few more, it will be interesting to see what we think of them when we return next June. And the razor clams - we had them today along with the oysters as clam chowder, boiled shrimp, along with Tim's scallops & orzo and fresh sauteed Chanterelle mushrooms. A good and filling time was had by all.

Now the lowdown on this week's treatment. I was puzzled and perhaps a bit concerned last week because I still hadn't had a reaction to my last treatment. I did have an amazing set of itches that were not particularly pleasant (and still aren't). But nothing else until Friday afternoon. As we headed for the coast, my face started feeling hot - just like the first go around with the "nuclear option". Uh oh. The pictures above on the beach show it starting as the rosey red glow, which later felt like someone taking a blowtorch to my skin. I apologize to anybody who saw me today - I look like a cooked lobster (perhaps my penance for consuming and enjoying the seafood???). The rest of the rashy skin breakout is now starting as I write this. The Jekyll and Hyde transformation begins again... A warning to my coworkers - I may not be pretty on Monday - the setting looks like it's going for maximum ugly again. I can't wait to see what I look like in the morning.....

A Bird of Paradise at a flower stall in Pike Place.

An apology to my nurses

It's always nice to spend a little more time at Pike Place Market. We stopped by for a little shopping to fill out the grocery/spice list for Thanksgiving dinner, after having stopped off at the hospital to have Silent Bob disconnected. I had a mission at the market - check out the shellfish. National Public Radio had a feature story about oysters last Tuesday night that stayed in my head all week. Many of our local bivalves were noted. I have decided that next weekend will have to be devoted to shellfish appreciation, with a sampling of all of the different local oysters (and one or two from further away) - Kumamotos, Olympias, Penn Coves, Quilcenes. The story is at http://www.npr.org/templates/story/story.php?storyId=16250281. To get in the mood, I picked up a bag of Penn Cove mussels which ended up as lunch today, steamed in Belgian beer and shallots. And next weekend is also the second short season of the fall for razor clamming, so I expect to snap up a few of the elusive clams (really, they are elusive - they really do move quickly as you try to excavate them).

A relatively uneventful week at the treatment clinic this week. I think I owe my nurse this week, Jenny B, an apology for being a difficult patient. She was working with a new nurse to the oncology group and did an excellent job explaining the four-page list of pre-medications and medications to be administered that day. But like I said, I'm a difficult patient - it's not that I cause trouble, but I guess I'm a little more sociable than most of the patients. It's not unusual for other patients to come and visit me, or for me to go visit other patients for a chat. It's a way for us to stay connected with each other, compare notes on treatment, and offer a sympathetic ear when things aren't going quite as well as hoped. But I think it makes a little more work for the nurses, trying to keep track of us all, as our IV trees sound off and they try to figure out who needs to have a bag of meds changed out. And it's probably a lot more work if you're trying to provide instruction to a new person and your patient keeps moving around on you. The nurses do a pretty good job of adapting to our mobile ways, and if I end up parked at a different station, somebody else will keep an eye on me until I go back to my own chair. I offer an apology if I've made taking care of me more work than necessary.

My treatment puzzles me. My first round of the nuclear option fries my skin, and then the following round does nothing except make me too tired to stay awake. And with virtually no obvious skin rash this time, I guess the latest set of numbers are not a surprise with an increase up to 8.6 from the previous 5.4. So now I wait to see what the third round will bring - itches, rashes, fatigue - who knows what I'll end up with this time.

Regardless of what ends up happening, I plan to enjoy a little time off for Thanksgiving, and hope that you enjoy it as well.

Zzzzzzzzzzzzz........

Maybe I'm taking last week's bear costume too seriously. Or maybe it's "method" acting and I'm still working through the part. Or maybe it's just the last round of chemo that has let me appreciate the benefits of hibernation. While black bears (Ursis americanus) are not true hibernators, they do go into a state of near-suspended animation for sometimes as long as 100 days. They usually don't leave their dens, and do not eat, drink or poop (does a bear s*it in the woods? Nope, not during hibernation) for the entire time. They're well insulated with their dense fur and thick body fat (OK, you can stop drawing comparisons already), and may lose a substantial amount of weight during hibernation, as they metabolize stored fat reserves (I did lose about 4 pounds on my last weigh-in).

Yep, that last round of the "nuclear option" was quite a bit different than the first one. No skin rash whatsoever so far, but I have been really, really tired and thinking that hibernation seems like a pretty good lifestyle right now. I can't say that I'm getting a good night's sleep, but I do seem to sleep a lot when I can get a chance, and if given that chance, I'll take it.

I sleep in the van-pool to and from work, I nap when I get home from work and nap after dinner until it's time to go to bed. I'm hoping that this too will pass, or probably until I go back for another dose on Thursday. The complete lack of a skin rash (other than that amazing and constant itch) is a bit puzzling, and while I don't really want to get it, it has me wondering if the chemo is still working. I have a theory as to why the first round of the "nuclear option" was so severe - I had a dose of Erbitux the week before I started the double-dose. From past experience, I know that it takes a few weeks to get it out of my system, so I already had some still working on me when I got the first double-shot. Note to self: Next time, take a little break before ramping up the dosage.

I've been struggling with articulating my thoughts (and not just from chemo-brain) on my last visit for treatment. It was tough for me to come in after having my worst experience with side effects to date. But that's not what was so difficult about this particular visit. What made this visit more difficult was the emotional wear and tear that cancer causes has started to show a bit. The job of being a valiant cancer warrior eventually wears down patients and their families. Maybe it just seemed more noticeable this time. Life through the "cancer goggles" sucks.

Seasonal musings

This time of year, I get to celebrate three things in the span of a few days. Halloween on Wednesday (some of which you have seen in last week's posting - sorry if you weren't able to open the pumpkin slingshot video clip), the Mayan El Dia De Los Muertos (Day of the Dead) on Thursday, and my birthday on Friday.

Halloween was celebrated at home with usual dispensing of candy treats to make the neighborhood kids wired with sugar overload, and at work with some costumery. Our original plan at work was to poke a little fun at the newly painted interior of our building, which was redone in what we felt was in an institutional palette - like a correctional institution. So 42 of us ordered bright orange jumpsuits and stencilled "INMATE" on the back. This almost worked, but someone in the building thought that it would be "disrespectful", and we got an email from Human Resources that the jumpsuits were out. Well, maybe out for most people, but I still had to get one picture with the jumpsuit on in the office.

The alternate costume was a bear - back at the end of last May, a wild black bear was running through the south Puget Sound, and it was finally captured and tranquilized on our campus. So I became "Columbus the Travelling Bear" for the day.

The ID badge bore the disclaimer "In no way is this costume intended to disrespect bears or other members of the Ursidae Family".

Closeup of the "tranquilizer dart" stuck into my rump.

The Day of the Dead is a celebration to honor the deceased in Mayan culture, and still celebrated in Mexico and some Latin American countries. It is my opportunity to celebrate another year beating cancer and not joining the ranks of the deceased just yet (remember "I'm not Dead Yet"?). The good folks at Rogue Brewing in Newport OR brew up a nice ale to commemorate the holiday - Dead Guy Ale, and I use this as part of my celebration.

The birthday part - I celebrated my 50th trip around the sun this year, which by my calculations, comes to approximately 28.2 billion miles. We'll defer this year's celebration for a few days while my body adjusts to last Thursday's round of treatment.

This week's marker number is back down at 5.4, and we'll see if I get the same terribly unpleasant Jekyll and Hyde transformation that I got with the last double dose of Erbitux, which I have now come to call "the nuclear option".

"Bob - what has happened to your skin?"

Happy Halloween!

We start this week's posting with a picture of our entry in a pumpkin carving party that a friend has every year (thanks Kristi!). Our "pumpkin totem" won in the "Scariest Pumpkin" category this year. I hope that our offering to the Great Pumpkin Spirit through this totem will be bring us all good fortune, if not plenty of pumpkin pie as well.

This was my first week on the new bi-weekly treatment schedule. As a way of saving me from coming in for treatment on a weekly basis, we doubled the dose of Erbitux in my last "full-meal-deal", giving me last week off. I guess the best way to describe my impression of how it went is that I think Halloween came for me last Monday. I'll spare you the details, but I gave myself a pretty good scare when I looked in the mirror on Monday morning (more than the usual first glance fright). For those of you who saw me in person, that unusual facial coloration was not from overdoing the sun in a tropical clime. I can't say that I've ever had a "sunburn" that was quite like this one - my new best friend is a wound gel originally developed for burn patients (for those of you who are going through this, e-mail me and I'll share product info). When it comes time to do this again on Thursday, I'll have to give some serious thought as to whether the three days of pure hell were worth skipping the weekly visits. If the next few days are pure bliss, perhaps we can call it a draw. In either case, I sure hope that the cooties inside were equally uncomfortable and are now ready give up.

Nothing helps you forget your troubles quite like smashing pumpkins. I'm not talking about the musical group Smashing Pumpkins (ask your kids about the group), although some of their music isn't bad. I'm talking about the thrill of hurling vegetables with the aid of considerable mechanical force at a distant target. I'm talking PUMPKIN SLINGSHOT. We went down to Spooner Farms in Puyallup yesterday to launch punkins into low-earth orbit. We're talking VMDs - Veggies of Mass Destruction!

The attached clip is my first attempt at including video - you may need Apple's QuickTime movie viewer to play it. We didn't manage to hit the targets at the other end of the field (prize for a direct hit is a BIG pumpkin), but I think we managed to give a bunch of little punkins the ride of their lives. And not to worry about what happens to all the mushed up ammunition - the local wildlife cleans it all up in about a week. Thanks to my buddy Angela for turning us on to this little bit of goofy mayhem.

And finally, a reprise of last year's special Halloween-edition PET scan. It's a real scan of my innards, and my first attempt at learning the intracacies of interpreting radiological imaging. A bright orange color indicates increased metabolic activity, which may help identify active tumors. On first glance, the glowing stuff in my liver reminded me of a grinning Jack-O'Lantern. With a little editing, it became a "Jack-O'Tumor", and provided a wee bit of entertainment to my friends at Swedish Cancer Institute.

A year later, this image still cracks me up. And I know what you're thinking - that bright spot in my head is not a tumor. It just shows that my brain was active at the time the image was made (note "active" there means quantity of activity, not quality). And I didn't make that particular spot glow with any editing....really.

Don't put it off - get screened!

D'oh! I forgot something to include with yesterday's posting. I forgot the obvious soapbox lecture about early detection and screening. This is a perfect example of putting my money where my mouth is - had I skipped the PSA test (why would lightning strike twice in the same place - OK maybe that's not such a good phrase to use with someone who has already nearly been struck by lightning twice), this might go undetected and ignored.

This past week's news in the public media about cancer is that the number of new cases have decreased since last year by 2-3%, and especially cases of colorectal cancer (down 5%). That's great news, although for those of us already in the battle, still not quite good enough, but that will be the subject of another blog. But the key to much of the decrease is that early detection and screening can prevent cancer and can keep it from getting to an advanced stage.

So, here is the message one more time - don't put off those screening tests. Men - PSA tests, testicular self exams; women - breast self exams, mammograms, PAP smears; everyone - colonoscopies, exams for unusual moles and skin blemishes. Got any kind of family history with cancer? Be sure to tell your primary care physician so he/she can keep up with screening exams as well and maybe recommend some earlier testing than normally prescribed. And be sure to keep your family and loved ones in the loop - if you can share information, you may be able to help cancer researchers narrow down genetic causes of cancer. Still think it's too much trouble? Re-read my October 14 post ("Does cancer hurt?") and see if you still think it's a good idea to skip screening exams.

Fall colors in Stevens Canyon

I should take up smoking...

...And maybe I'll start eating red meat again, and have another glass of wine with dinner, and eat more chocoloate, and drive another mile or two above the speed limit, or run with scissors or any of a number of more "risky" behaviors. Why? Perhaps as some kind of bad cosmic joke on me, I may also have prostate cancer. As part of my last routine physical exam, I had a PSA (prostate specific antigen) test - it's a blood test similar to the tumor marker numbers that I've been routinely sharing with you for colorectal tumor growth, except that it's specific to the antigens produced by the prostate gland. Like the other marker numbers, an increase in the number may be indicative of possible tumor activity. I received the results Wednesday afternoon, after I had just returned from having another CT scan done. Surprise! The PSA number showed an increase from a previous measurement into a level that merits further evaluation. You would think that with all the chemotherapy I've been subjected to, that no tumor could possibly initiate. But you might be wrong. Is it anything to worry about? Probably not. Nothing detected on the CT scan, and really not worth the trouble at this point to have it biopsied. We can do the PSA test again in a few months with my regular blood work and keep an eye on it, or if I'm really craving entertainment, I can have another another "digital" examination performed. Prostate cancer tumors are typically slow in growth, and frankly are small stuff compared to what I'm really trying to fight right now. Now that I know that Dr. Gold checks this blog, I'm not allowed to quote him directly, but in a nutshell, it more or less amounts to "let's worry about this after we take care of the other stuff".

Another way to look at this is the memorable scene in "Butch Cassidy and the Sundance Kid, when Butch and Sundance are trapped by a posse on a high cliff above a waterfall. They are discussing jumping far down into the pool below to escape:

Butch Cassidy: Then you jump first.

Sundance Kid: No, I said.

Butch Cassidy: What's the matter with you?

Sundance Kid: I can't swim.

Butch Cassidy: Are you crazy? The fall will probably kill you.

Not to worry about possible prostate cancer, the liver tumors will probably kill you first. It's not like I've been so bored with the cancer I already had that I thought I should shop around and try out another for a test drive. Really, it would be kind of backwards to start with a Stage IV cancer with immediate life-threatening consequences, and then pick up an easier cancer to treat just for a little extra practice. Shouldn't I have done the prostate cancer as say a "starter" cancer first to get the hang of it and then graduate on to the metastatic colorectal cancer? So, in the mean time, I might as well live it up, right? OK, maybe I don't need to pick up a tobacco habit and go for the trifecta of getting lung cancer as well, but the extra chocolate probably wouldn't be too bad.

About the CT scan - really pretty unremarkable. Stable, stable, stable - no changes. My favorite phrases in the radiologist's report: "A normal appendix is appreciated" (I sure appreciate it greatly for it's normalcy), and "Skeletal structures are unremarkable for age" - unremarkable? Gee whiz, not even just a little impressive? Marker numbers this week - up slightly to 6.4, but again, nothing that I'm losing sleep over.

And about my last posting - you may have read the description of what chemotherapy does to me and went "whoa". I didn't mean to upset anyone, but for those of you who are also going through this, it's not just me that experiences this - you've been through this is as well. It's not fun for any of us, but we grit our teeth and bear with it because we'd still much rather live with it and get past it, than to throw in the towel and give in.

Snow falls in a pass in the Tatoosh Range

Does cancer hurt?

Gee whiz - the last time I wrote was September 23! Not that I haven't had the desire to sit down and write, but more that I've either been too tired to get very far and decided that a nap was a better choice, or that I've been tied up with household things (like replacing the broken dishwasher), or otherwise busy with the welcome visit of out-of-town houseguests.

A little catch-up first. The last set of marker numbers are from last week - 5.4. Up a tiny bit from the last set, but not statistically different. I will also be changing my treatment regimen this week and dropping back to biweekly treatment, but doubling the dose of Erbitux that I receive. It will make the long full-meal day just a bit longer (by about 30 minutes), but it means that I don't have to make the weekly pilgrimage to the treatment center. The double dose seems to be effective in Dr. Gold's patients who have tried it, and was the topic of discussion at a recent meeting he attended. The side effects are said to be no worse than the present ones (but not better either...dang). I'm hoping that when given with the full-meal deal and the steroids, I still get a 3-5 day honeymoon from side effects.

And about those side effects... The subject line was inspired by Leroy Sievers' blog on Friday (thanks to Leroy again for providing inspiration). He has recently undergone surgery to replace a spinal vertebrae that had a tumor and was weakened. Given all the procedures he has endured to battle his cancer - chemotherapy, radiation, gamma-knife surgery, cryo-ablation, radiofrequency ablation, vertebroplasty - that he would have been ready to address the question "Does cancer hurt?" before now. After his surgery, it's been hurting him a lot - recovery from major surgery is frequently painful, and this has been especially painful. It didn't start out that way, and from reading his blog, it's evident that the previous procedures were not without pain, but that this one has now set the bar for pain quite a bit higher. His conclusion - cancer does hurt. In my case, I couldn't agree more. The past month has been physically more challenging than anything else I've experienced - tougher than any climb I've done. Chemotherapy started out pretty easy and the pains were more of a nuisance than anything else. As time has worn on and the "novelty" of cancer has worn off, pain has been more of a constant companion. I get a few days off when the steroids are working, and I've grown to looking forward to that little honeymoon. But within a few days, the little aches and skin rashes start up. The constant itching makes me irritable (there's that Irritable Bob Syndrome again) and I end up with scratches when I wake up in the morning that invariably get infected - time to renew the standing prescription for antibiotics. Within a few more days, the skin splits open on my fingers and heels and the bottle of liquid bandage stays within reach for touch-ups. I bleed a lot - all over - I have to avoid wearing light colors that won't show bloodstains. By then, my mouth and lips start developing ulcers and eating and speaking become incredibly painful - enough to bring tears to my eyes at times. That puffy lip thing works pretty good for Angelina Jolie, but it looks like hell on me. And strangely enough, if you walk up to me and ask me how I'm doing, I'll usually say "OK - I'm getting by." Yeah, cancer hurts. It hurts a lot. And when they ask me every week if I want to skip treatment, I always say no - if I can shorten this by even one week, I'll keep doing it.

While on my last steroid honeymoon, I had houseguests from out of town. It was nice to take a little break and show off where I live. I finally got a chance to get back to Mt. Rainier to show it off to my guests. I hadn't gotten the chance to visit there since I started chemo. It was beautiful - the lower elevations were in full fall foliage glory and snow was falling at the Paradise visitors center. It was great to be back.

Silent Bob visits Mt. Rainier

The view towards the Tatoosh Range from Reflection Lakes.

An old question revisited

Leroy Sievers had a blog posting regarding this cartoon a few weeks back. It seemed oddly appropriate at the time, as I was spending the day in the hospital for my weekly basting. Fortunately, no one has spotted any doctors with rifles in the hall so far.

Leroy posted a blog recently revisiting an old question - who should we tell, and how should we tell them? It would seem that by now, everyone who knows me, knows that I have cancer. But there are always new acquaintances that pop up where you have to wonder..."What would be gained by telling them I have cancer?". Is it fair to start up a new relationship with someone and leave out that little detail? Or are you gently playing the "cancer card" by letting it slip into the conversation to see what kind of reaction it will elicit? Early on, I was pretty indiscriminate and told everyone - perhaps I could have been more subtle and measured. But it's not news any longer, or at least not for me - it's old news, been there, done that. The cycles of treatment continue on. It's not that I'm just shrugging off cancer - there is scarcely a moment that I can't feel the effects that treatment has on my body. But at this point, I'm less inclined to bring it up when meeting someone new. It just doesn't seem necessary.

Sorry that I've been a bit behind in posting. Between just being busy at work and home (remember, life continues on, cancer or not), and just being a little physically run down, I didn't get anything posted last week. My marker number went back up to 8.5 two weeks ago, and then just as quickly as it went up, it slipped back down to 5.2 this past week. I'm betting that with the reaction that I'm getting already from the last treatment, that we get another big drop. We'll see in few weeks with the next set of measurements.

Revenge is sweet

Not really revenge exacted by me mind you, but revenge I deserved to receive. You may recall that a few weeks ago I attended my Dad's wedding. We had the opportunity to play a few pranks on him as part of the festivities, including leaving a few things behind in his house. The treasures we left around the house featured a somewhat tacky flamingo motif, among other themes. I expected some kind of payback, and sure enough, a package arrived in the mail from my Dad. The picture to the right shows my Dad's response to the flamingo theme - an illuminated plastic flamingo, which now proudly graces our den and brightens the evening for us. Thanks Dad, and the book was cute too - touche.

No numbers to report this week - a minor mix-up with the lab work order and the marker numbers didn't make it to the order. I'll probably get them done this week instead. I thought the lack of test results was because we've been having more difficulty in getting a blood draw from my port in recent weeks and didn't draw enough on Thursday to get all the tests done. When we can't get any sample out, it sometimes means that tissue has grown over the end of the catheter implanted into the large vein returning blood to my heart. The little flap of tissue will allow fluids to be administered, but not withdrawn and may eventually completely clog the catheter. The only way to get rid of the tissue is to fill the catheter with an enzyme that dissolves the tissue, and wait for another hour. (I was told that this stuff was originally derived from rattlesnake venom, but it's not nearly as exotic now - it comes from engineered e. coli bacteria, which is cool but still not nearly as cool as venom.) Anyway, this adds a lot more time to my day in the big green chair, so we try other methods first. Sometimes we can undo a blockage by having me stretch, cough, laugh (laughter the best medicine? It's free too!), or otherwise move around. When this happened a few weeks ago, Sandy, who is one of my regular nurses in the lab mentioned the "Valsalva maneuver" as something we might try sometime. I had to look it up as soon as I got settled into the big green chair, just because it sounds very clinical and important: http://en.wikipedia.org/wiki/Valsalva_maneuver . It amounts to pinching your nose, closing your mouth and exhaling forcibly. It causes blood to temporarily dam up and when you release the pressure, the blood is free and rushes more forcibly through your veins and arteries. I had a new nurse on Thursday, and when we couldn't get a sample, I mentioned trying the Valsalva maneuver, as if I really knew what the hell I was talking about. She was suitably impressed by my vast knowledge of medicine (what would we do without wikipedia?), but Sandy came over and blew my cover. Let's give it a go, and sure enough, after the first try, we managed to get a little flow. A second attempt (which made me a little dizzy - a cheap, but probably not too smart buzz for you thrill seekers out there - just don't blow out your Eustachian tubes!), did the trick. I'm glad that I have a good relationship with my nurses - we might have had to do the enzyme thing one more time if we hadn't tried the Valsalva.

Another thing to take away from my last visit - I guess what doesn't kill me will not only make me stronger, it might may make me smarter too, and I can always use that kind of help.

Hollyhocks swing in the breeze in my backyard

Labor Day

One of the side effects of the combination of drugs I get in chemotherapy is that it makes my skin do unpleasant things - my face and neck turn into teenaged nightmare skin, my chest and back likewise. I have a friend at work who had (I say "had" because he is now in remission) a rare form of cancer - he has only one eye - he lost the other from his cancer. When a man with only one eye notices that your skin is in rough shape, you know it must be noticeable. He gave me a friendly jest about it, as only someone else in the same boat could be allowed to do and gave me a hug.

Those are my fingers in the picture. The chemo makes the skin on my fingertips and heels split open like overripe fruit, so sometimes simple tasks like picking up small objects, fastening buttons, typing, or walking provide a constant reminder that chemotherapy is not fun. Fortunately, it's not like this all the time - I get breaks of a few days here and there in the weekly and biweekly treatment cycles. That's when I get to be more like my "bc" (before cancer) self and sneak in a little gardening or household repair work and make my fingers look like this again - the good old fashioned way. Today was one of those days - I've been enjoying sweet cherry tomatoes in the garden and planting more perennials in the yard - a few treats for now in the tomatoes and a few treats to come with new plants in the ground. It's pretty good motivation to put up with the treatment.

These are some of last year's crop - planted when I was first diagnosed.