I don't know how this happens, this passage of time between blog posts. I've thought of about a hundred things to write about, but I haven't taken the time to write any of them. The main reason is that my primary blogging time occurs after the kids are in bed, but lately I've been stealing that time for exercising. I think it's a worthy substitute under any circumstance, but particularly since I'm training for something.
I'm pretty sure that this is the first physical goal that I've ever had in my entire life, and it's a good one if I do say so myself. At the end of June, the spouse and I are taking a trip WITHOUT THE KIDS (they'll be at grandpa and grandma's, so don't feel too badly for them) for the first time ever to go and do this: Hike the enchanted valley in Olympic National Park!
I am so freaking excited! I've been craving a mountainous adventure ever since my brother's friend made me this last summer:
So I'm doing it! I'm going on a big ol' hike in the Olympic Mountains!!
I asked my brother how to train for such a thing, and his response was one word: Stairs. I said how many, he said just do a lot. I said how often, he said whenever you can. So, I've been walking around this flat town a couple times a week, wearing a backpack filled with old textbooks, and incorporating at least a few minutes of stairs down into the floodplain that is a city park. It'll do, it'll do.
I've been up to other adventures, too, but I think that they are worthy of their own posts eventually. Some have been quite poignant and moving for me. I'll find the time to write them up, I swear. One quick point I can make is that it is clear that my hemoglobin is at long last in the normal range for a healthy human being. PSA: Please don't take for granted how fabulous you feel. Thank your hemoglobin. It was not until I started feeling so fabulous that I realized how tired I had been for so long. Every day I feel more and more fabulous. Fabulous.
In other news, I'm pretty sure that I forgot to post the news that my PET scan last month was TOTALLY CLEAR again. That's two clear ones in a row, huzzah!!!! Not sure yet if I get a longer leash in terms of extending the time between PET scans. Dr. Oncologist would prefer to have a longer leash and therefore fewer PET scans, but I need to consult with Dr. Medical Oncologist (Her2 expert) and get her opinion. I'll have that appointment in July or so.
Alright. I've finally got my hbomb back. Sorry if I scared any of you, but thank you for all of the extra support I've received. Some of your words and gestures were deeply touching, such as the books from Nebraska, the email from Wisconsin, and the bead delivery. I love you all. I'm sure that they are the direct cause of my improved mood.
A few other things have helped me to feel better. 1) Last night I escaped from my life by going to the cinema. I haven't been to see a non-animated movie in an age. My friend S was my buddy, and I inadvertently tested her friendship by dragging her to a Woody Allen movie. I'm so out of the pop culture loop that I didn't know it was written by Woody Allen! I just saw that there was a Colin Firth movie playing (I love Colin Firth) and I hastily dragged us to it without doing further research. This is pure neglect on my part, considering the various modern technologies I could have employed to spare us from this tragedy. In all seriousness, Colin Firth was excellent and the story was unique, so we just rolled our eyes at the pretentious scenes while we happily munched on our popcorn.
2) This afternoon I hosted an ice cream social at work. An undergraduate student who has worked in the lab all summer is returning to her institution next week, so someone suggested an ice cream party to celebrate. I brought the ice cream and everyone brought a topping to share. The result: a lovely half-hour with my awesome co-workers eating the fanciest sundaes imaginable. Sure we had hot fudge and strawberries, but would you believe that someone made homemade candied ginger? And homemade cinnamon toast croutons? I don't think any of us stopped at one sundae. You'd be in a better mood, too, if you had sundaes like these.
3) I took my daughters to the pool tonight. I put my hat on Eleanor so that I could stand under the waterfall and let the water massage my shoulders. I tried to get her to hold my sunglasses, too, but she couldn't get them to stay on her face and so she moved to set them down...in the water. I decided it was best to hold them outside the waterfall myself. Also, watching my girls hold hands as they ascended the steps to the waterslide was pure bliss.
I've rapidly progressed to the point where I'm so ready to be rid of this toxic breast it's not even funny. I don't know how I can possibly wait until September 10th. Oh yea, I suppose I'll be busy recovering from tomorrow because...
...IT'S MY LAST HARD CHEMOTHERAPY! Woo hoo! I'm oddly excited, like almost as excited as I feel before a trip or a show or something. I've already got the coffee pot filled with water and decaf grounds, set to brew at 7:02. My intentional choice of the odd time of 7:02 makes me even happier.
I'm pretty sure that I had more things to say, but my friend F just sent me this awesome mix via Spotify. Now I'm distracted by these fantastic tracks. Here's one for you.
As I hope you gathered from my previous silly post, I was once again hospitalized for neutropenia. I was in bad shape last Friday--dizzy and weak with absurdly low blood pressure. This was because I had no blood in my blood! Dr. O said it herself, "You have no counts." She admitted me for the weekend just to play it safe, to prevent me from catching anything infectious from Other People. Being in the hospital definitely limits my contact with other humans and their infectious diseases, although I have a healthy fear of hospital-acquired infections.
I was a much more willing patient this time around. The first time I was hospitalized I really did not want to be there. I missed my system of wellness that I had at home. This time, however, I entered the hospital with all of the tricks that I had learned the first time, plus an appreciation for not being at home. That is, at home I incur a lot of incidental activity, such as climbing stairs and playing with the girls, that when I am super sick are perhaps better avoided in order to maximize rest and recovery. Regarding hospital tricks, these include ordering food before you are hungry, ordering Tums before you have heartburn, and requesting bathing supplies before you actually want to shower. I found this level of premeditation to be exhausting and frustrating the first time around, but I managed the system better this time and therefore suffered less.
Another bonus about this hospitalization is that Dr. O decided to give me a dose of blood products, specifically Red Blood Cells. I love blood products! To steal words from my friend M, it is truly my Go Juice. I feel significantly better today than I did on this day three weeks ago (that is, on the equivalent day of my last hard chemo cycle, get what I mean?). Everything is less--less dizziness, less nausea, less fatigue. It's all thanks to someone else's Red Blood Cells, hard at work in my body. I am grateful.
This is a good opportunity for a public service announcement, encouraging you to consider blood donation. I have donated blood in three different states, reaching the 1-gallon mark in one state, but I will never again be allowed to donate blood because of the whole cancer thing. Blood donation is an easy thing for a healthy person to do, and it makes a huge difference in the lives of the unwell. Please contact the Red Cross for blood donation information in your area. Thank you to all of the blood donors out there, including all of my parents!
The only way to end this post is by expressing my excitement at finally being on the good side of the third and FINAL round of FEC (5-fluorouracil, epirubicin, and cyclophosphamide). Recovering from this drug combination has been the hardest thing I've ever done--harder than my first cancer fight, two natural childbirths, writing a PhD thesis, and commuting in rushhour traffic as a 15-year-old COMBINED. I feel positively ELATED. I don't even care that I still have three more rounds of hard chemo to go (taxotere, herceptin, and pertuzumab--the taxotere makes it "hard"). It will be so much easier. The worst is behind me.
If the worst is behind me, then I have reached the summit. My brother's friend J made a movie for me on this subject. J is a mountain climber. He and my brother climbed Mount Rainier last month, and J was inspired to make this movie for me. It includes footage from some of his other Rainier climbs. The photo at the end is of my brother and I when we hiked around Rainier in August of 2010 (note the change in verb from "climb" to "hike"--my feet did not touch the mountain proper). The beauty of this 1-minute, 20-second movie jerks my tears every time, so don't say I didn't warn you.
Several people have asked me recently, what are neutrophils? That is a great question, and I can't wait to show you how amazing neutrophils are. I "phoned a friend" to help me with this post because she is a talented neutrophil enthusiast. R is one of my best friends from graduate school and has been studying neutrophils (among other things) for several years. I asked her to write a list of things my audience should know about neutrophils. Here it is, complete with some truly amazing movies that show neutrophils in action. (If you only have time to watch one of the movies, let it be the first one, "neutrophil chasing bacterium". It will blow your mind! This happens in YOUR body!) So sit back, open your mind, and release your inner nerd! Enjoy!
Neutrophils Fun Facts (in no particular order):
1) They’re the first line of defense against bacteria--when bacteria arrive someplace in your body that they’re not meant to be, like a cut in the skin or an abscess in the mouth, a variety of signals are released that make neutrophils migrate to that site, where they do their best to eradicate the infection. Below is a movie of a crawling neutrophil chasing a bacterium.
2) They’re what pus is made of! The white goo that we call “pus” is actually a big glob of white blood cells, most of which are neutrophils, that have come there to fight infection. Also, one of their main enzymes contains iron, which is why pus is often a little greenish.
3) They live for less than a day--the life cycle of a neutrophil is estimated to be 10-18 hours, although recently a controversial paper suggested that it could be longer, more like 5 days. During their lifespan, they are born and mature in the bone marrow, and then circulate throughout the bloodstream, waiting to detect signals of an infection that requires their presence.
4) Neutrophils can totally change their shape as the situation requires. In your blood, they are completely round and can roll along the sides of the blood vessels. To squeeze between cells, they can deform themselves and squeeze through a gap roughly 1/10 their size. Once in the tissues, they flatten out and develop a leading migrating edge--imagine a bloodhound with its nose to the ground, scenting a trail; this is how they move when they’re trying to follow a chemoattractant path to get to an infection.
Below is a movie showing how neutrophils roll along the walls of a vein and squeeze through the wall when needed.
5) If they don’t find any bacteria to fight, they undergo programmed self-death (apoptosis), and then mark themselves with a molecular flag for other cells (macrophages) to clear them away.
6) They are superpowered killing machines. Neutrophils’ job in the body is to kill invading pathogens, and they can do this in a variety of ways:
Phagocytosis- Neutrophils can eat bacteria, and once they’re inside, kill them via production of extremely toxic free radicals (aka the things that antioxidants protect you from!). Amazingly, the neutrophils can kill the bacteria this way without damaging themselves.
Degranulation- not all neutrophils responding to an infection will meet up with a bacteria to kill. If a neutrophil senses that its killing abilities are needed but doesn’t know exactly where, it can release all of its toxic weapons into the environment near the infection. This includes a number of cool things:
Antimicrobial peptides- these are compounds that kill all kinds of bacteria, often by punching a hole in their membrane or starving them of necessary metals.
Digestive enzymes- neutrophils manage to store very powerful enzymes in granules without hurting themselves, but once they are secreted they go to town digesting everything in sight.
Reactive oxygen species- you know how you can put hydrogen peroxide on a scrape to disinfect it? Well, neutrophils not only produce compounds like hydrogen peroxide, they make an enzyme (myeloperoxidase) that makes these compounds even more toxic. Bad news for bacteria.
DNA nets- This is a supercool finding of the last ten years. Neutrophils can actually excrete all of their DNA, which is sticky and acts as a “net” to trap bacteria, keeping them in place so they can’t escape the other killing mechanisms.
7) Neutrophils are the most abundant immune cell in the blood-- they make up about 50-70% of your circulating white blood cells.
8) Because neutrophils are such powerful killing machines and can release their molecular weapons indiscriminately, it’s very important that we regulate their behavior and make sure they’re only deployed when and where they’re needed. This is accomplished by a step-by-step cascade of signals--picture the game mousetrap, where the neutrophil starts in the bloodstream and ends up killing bacteria in the tissues.
9) (This one was added by Heather, because the relationship between neutrophils and neutropenia is a common question that I get asked) The importance of neutrophils in fighting infections is why it is a serious health risk to have too few neutrophils. Having too few neutrophils (below 1000 in a blood sample) is called neutropenia. Neutropenia can be caused by a number of medical issues, including chemotherapy. There is one treatment that can help increase neutrophil levels, and that is a drug called G-CSF (granulocyte-colony stimulating factor). The formulation I have been given is called Neulasta, but there are others as you can see if you follow the link. This formulation in Neulasta is auto-regulated, meaning it starts to work once the levels of white blood cells are low. This is why my white blood cell counts experience a lag--I'm neutropenic a week after receiving Neulasta, but then the Neulasta kicks in and fixes me right up. Once my white blood cells increase, they get rid of the Neulasta and my body takes care of itself again. This is important because you wouldn't want Neulasta, or any formulation of G-CSF, working all the time, because having too many white blood cells is a different kind of problem.
Please post questions in the comments section. R and I will either answer them ourselves or direct you to a resource that can. We hope you enjoyed learning a bit of biology today! Also, for those of you who pay attention to every detail (ahem sisters), no I did not write this post on my sickest day. I pre-wrote it and set it to post automatically for you, my dear readers. All my love!
I'm emerging from the depths of chemotherapy at last. I started the day with a walk, during which I marveled at the blue skies, chirping birds, and frozen fractals on the ground. Then I was spent and needed a rest, but look how quickly I rebounded! Already I have energy for typing, whereas yesterday I would have slept for two hours to recharge. My fingers are moving faster than yesterday. If only I could figure out how to stabilize my guts, then I'll have this situation under control.
One hard chemo down. Done. Past. Complete.
Yesterday was a hard day, so to combat it I took matters into my own hands. Instead of being afraid of dying of cancer, or of feeling sick forever, or of my hair falling out, I gutted the fear with the blunt blades of childrens' scissors. My daughters wielded the scissors. My brother made the video (with a little help from Google's Auto Awesome).
After the haircut Ian buzzed my whole head for me. Now I'm ready. Let's do this.
Let's make this a multi-media blog post all around with another reason that I'm smiling today. Every day, someone has to flush my Picc line for me. The picc line deserves its own post and explanation, but here is the situation in brief: it is a long (50 cm?) internal tube that threads up my arm and into a big vein. An external portion is taped to my skin on the underside of my right arm, just above my elbow. The external portion has a button in it, and through this button folks can get blood out or put medicine in. Ten mls of sterile saline needs to be injected into the button every day that the picc line is not being used for something else. I can't do it myself because I only have one hand that can reach it.
Enter my brother (the OC). He has been flushing my picc line for me every day, and today it came to light that he enjoys doing it. He said he's always wanted to do something like this, ever since that scene in Con Air when Nick Cage has to inject his own heart in order to save everyone. OMG, I was dying laughing! First of all, that movie came out like a million years ago; secondly, imagining Nick Cage flushing my picc line to save lives is hilarious; thirdly, wasn't it actually The Rock, NOT Con Air? But what's the difference, right? LMAO. Ryan couldn't find the precise clip on YouTube, but here is a scene from The Rock that explains the situation. Trigger alert: terrible language, stressful situation.
That's all for now. I need to go find more crackers. :)
I've been wanting to do this after several PET scans now, but I was uncertain if I should put it on the blog or not since it requires a tool that I don't have at home. I suppose now that you know what I decided, the only remaining question is, regarding what?
As I have explained previously, the purpose of a PET scan is to detect regions of increased metabolic activity in the body. Increased activity is potentially indicative of cancer. This activity is detected by injecting a hungry person with radioactive glucose (sugar). The person then rests for an hour, and since the person hasn't eaten in awhile the sugar goes straight to the hungriest cells (cancer, if present). The radioactivity concentrates there, and when the person is scanned after the hour of resting this concentrated radioactivity (if present) is mapped.
What I don't think I've discussed previously is, what happens to the radioactivity after the scan? Well, it decays and goes away. The type of radioactivity used in a PET scan has a very, very short half life, so short in fact that the clinic receives a shipment of radioactivity for the morning patients and a separate shipment for the afternoon patients. Said another way, a shipment received in the morning is no longer radioactive enough to be used in the afternoon patients.
But there are several hours between "morning" and "afternoon". Needless to say, I was curious about how radioactive (hot) I'd be just after a PET scan.
Lucky for me, we have a Geiger counter at my place of work. A Geiger counter is a little box the size of a car battery with a microphone-like wand attached to it by a cord. When turned on it works much like a metal detector, making rapid beeps when it detects radiation nearby and only occasional beeps in its absence. My friend Sam was all too eager to use the Geiger counter on me, approximately 2.5 hours after the radioactivity was injected in my arm for the PET scan. Fortunately Torey had his camera. (Don't mind my ridiculous walking posture. Apparently I don't walk normally when I know there's a camera on me.)
Radiant indeed! I suppose that for as much as I hate PET scans, they provide a nerd's delight. Some amazing technologies are intertwined to make cancer detection happen, radioactivity and all. Nerd salute to physics!
Do you know what I just did? I took a mid-afternoon bath. I know that some of my readers, both male and female, are bath people. Indeed, I could name a few who I'm certain have experienced the midday tubbie. I myself, however, am not a bath person, let alone at a time other than night. But armed with my newly cleaned tub, I took the plunge and it was glorious. I am fighting a cold (please oh please don't turn in to a sinus infection, pretty pretty please) and I was dirty. I find myself wanting for more excuses, but that's all I've got. And that's okay.
I have discovered the best part of my family members attending college, pre-school, and daycare: more and better family time. When one parent's job was to stay home with the kids, the other parent was often rescuing the other parent from the job. Now the only rescuing we do is of the kids from their respective daytime activities. This leads to greater enjoyment of our time together. It's wonderful.
With this improved quality of family time we have had a most fabulous holiday weekend. My only regret is that I have not taken enough pictures, although I am glad that I have experienced it with my own eyes rather than through a camera lens. We grilled out with neighbors, we visited S. and her 4-week-old baby C., our dear friends Darci, Zach, & Sons came up for an overnight visit, and we went to the Gardens here in town. So many great photo ops, most of which I missed! But I did finish Eleanor's hat, and she modeled it for me.
We have a great abundance of tomatoes from our garden, and we are not (yet) canning people. So we have been making all sorts of delicious tomato things to make sure we eat them before they spoil. I have made vats of bruschetta topping and pico de gallo, and Ian has made four loaves of tomato bread (I can't link to a recipe because he just makes it up every time!). While he was making the bread, the girls played with flour and made their own creations. This is such a small fraction of the wonderful family time we had this weekend, but hopefully it conveys the message.
Has anyone ever told you how therapeutic it is to just to get out of town? Or even out of state? Add to that the joy that comes from spending uninterrupted days with one's precious daughters. Plus the delight of visiting old friends and getting to know their babies. It was just what the doctor ordered, even if it wasn't quite enough time away. There will be other long weekends.
Matt and Martha are the best hosts ever, and even the triplets were gracious enough to share a bathroom with us. M&M cooked and cleaned, cleaned and cooked, and even stayed up late to watch a movie with me one night. Fortunately our families are pretty much on the same schedule, so the visit was very smooth despite all of the childcare being performed. Activities included going to the library storytime, playing in the kiddie pool on the patio, walking around downtown and a bit on campus, and walking around the neighborhood. On Sunday we took nearly the whole day off from cooking by eating lunch downtown and ordering Shakespeare's pizza for dinner (Pat, it is indeed delicious, although I was more impressed by Sparky's ice cream. Two words: peach cobbler). In short, I was pleasantly surprised by Columbia, MO. Some photos are posted below, but click here to view more photos from our trip. Oh, and on the way home I bought ~4 dozen Missouri peaches from a roadside stand. I am literally speechless just remembering the juice dribbling down my chin as the rosy flesh burst between my jaws. That's right, those peaches are already gone. They were well-loved.
My sinuses are feeling great, although I didn't realize it until my in-laws asked me about it the other day. Yet another example of me taking my renewed normal life for granted. Anyway, I was never very congested even with my sinus infections, but I do think that the nasal steroids are improving the situation. I do seem to be getting more air up in there, and Dr. Ear Nose and Throat said that air is key to improving the sinus situation. I therefore think I am in the midst of a modest sinus victory.
I'm doing great. I've worked all three days so far this week, and I have probably 80% range of motion in my left shoulder. Still pretty sore, but it's coming along. I'm even learning to ignore the nerve pain. Forward progress is tangible.
Now here's the crud that I haven't mentioned yet. Remember last October when the mammogram of the right breast showed calcifications? Calcifications do not necessarily mean cancer, and the right breast has never shown any increased metabolic activity on Dr. Oncologist's PET or MRI scans. Dr. Oncologist and I were therefore not concerned at this time. (Increased metabolic activity would be indicative of cancer, so the negative results by PET and MRI are favorable.) Well, Dr. Surgeon decided to do another mammogram of the right breast on the morning of my mastectomy. Although I maintain that mammograms as a rule are not that painful and only last a second, this one was a super bummer because my port is right above the business...ouch! The calcifications were still there. Dr. Surgeon, therefore, has decided to biopsy the area with the calcification because I now have a history of breast cancer. Tomorrow I will see Dr. Surgeon to assess my (Wonder Woman) recovery from the left mastectomy and to plot the biopsy of the right breast that will take place on Monday.
At this point I feel like George from Monsters, Inc. He's this cheerful hairy monster who is minding his own business when his co-worker points out that he has a dangerous contaminant (a child's sock) on his back. Special forces swoop in and give him a rigorous decontamination treatment. He is left traumatized and hairless (see movie clip). The co-worker catches George with child contamination two more times in the movie. At first George suffers another treatment, but in the end George shoves the child's sock in the co-worker's mouth and saunters away. At the end of the movie, George's hair has grown in and he is happily back at work.
I am currently relating to the sock-stuffing George, although I plan to control myself and not exhibit any violence with any of my doctors. I look forward to relating to the happy hairy George in the near future.
