Beyond Gratitude

Carnation Nation, I am delighted to announce that you and my family did a very cool thing last week!  We made a charitable donation to my oncology clinic, directed toward oncology patients who need financial assistance for gas, food, etc. during their cancer treatments.  We made this donation in tribute to the specific physicians, nurses, and staff who have kept me alive this long (I specifically named individuals, which is terribly risky because I'm sure that I inadvertently forgot someone, but I'm trying not to worry about that).  And the FUN part was that the clinic organized a small surprise ceremony to honor the tributees and present them with a commemorative lapel pin.  My family was invited to attend, and the organizer said that they'd never had so many family members attend one of these before (I'm not surprised...my family is off the charts amazing!).  My heart was/is overflowing with gratitude for all of these people.  So many hugs were administered!  It was wonderful!!  Thank you, Carnation Nation, for making it possible to express our gratitude in such a profound way!!

My family with my Radiation Oncology Family. Hilary, your children's outfits are ON POINT. So adorable!  

My immediate family with my Radiation Oncology family. 

My immediate family with my Medical Oncology family.  I am a gigantic human in this photo!!  I've always been a back-row human, but they wanted the family in the front.  And my kids are adorable!

During the celebration, a member of the Medical Oncology family asked where my brother was?  My sister responded, oh, he lives in Seattle.  To which the Medical Oncology person shrugged, because she knows him as the guy who shows up.  You were missed, brother!  Can't wait to see you this weekend!!

My dad took us out to dinner afterwards to celebrate the occasion; the joy was running high, and it was lovely to keep it going.  Grandpa let the kids order the fancy desserts that they had been oogling in the case before we were seated, so everyone was super happy.  My sister's kids, in their matching outfits, about burst my heart!!!  Those smiles!!  Nothing beats cousin time for these guys.     

Happy kid table! 

Family dinner.  So special.  Thanks, dad and bonus mom!!

Fuzzy

We did it!  We shaved my head.  And I love it.  The long hair falling out was so messy.  Now when the remaining hair falls out it will just be little bits.  And I can oil up my scalp!  The girls had fun cutting it with scissors before the spouse took the clippers and buzzed it for me.  I appreciate their support so much!  Simple isn't easy, but hopefully they found a little bit of fun in this unique experience of cutting your mom/wife's hair because it's falling out everywhere.  This time I'm rocking the baldness WITH eyebrows!  Trust me...it makes a difference! 

The scalp isn't even the itchiest part--for some reason, my forehead is terribly itchy.  I'm putting Aquaphor on it, and that provides a little bit of relief.  But the skin appears to be completely fine.  It's not red or flaky or anything.  Just itchy.  When all is calm and I'm trying to rest, the inside of my forehead feels itchy, too, like the inside of my skull, so maybe it's just a sensation?  Who knows! 

Other new things:  super watery eyes and screwed-up tastebuds!  Perhaps whole-brain radiation is more like whole-head radiation! 

I've achieved my maximum dose of the short-term memory preservation drug, so hopefully I'll start to get used to it soon and stop being quite so tired.  Also, I've resumed my attempts to decrease my steroids--my plan is to try to reduce my dose by half a milligram a week, and I started Monday!  So far, so good.  My head doesn't feel any worse.  Huzzah!  Simple is not easy. 

At the family holiday party yesterday, Aunt Sandy kindly pointed out to me that the wooly bear caterpillars in my brain will eventually turn into moths and fly away, carrying Lloyd with them.  That's so wonderful!  Thank you, Aunt Sandy!  For now they seem to be enjoying their campout.  They are welcome to stay free of charge until they've burned Lloyd out completely. 

https://northernwoodlands.org/articles/article/transformations-which-caterpillar-becomes-which-butterfly

Fuzzy caterpillar camp-out

Folks (mom) are frequently asking if I'm feeling better.  Better than what?  In the old days, before cancer, if I felt better I took that to mean that I was done feeling unwell. Now, it might simply mean that I feel a little bit less crummy now that I've had a nap, or sure maybe I feel better than yesterday, or thanks for the hug it lifted my spirits and I do feel a little bit better now that you mention it, but no I am certainly not yet feeling like my old self.  Perhaps I never will, and that would be okay, because I'm so grateful to be here and things could be so much worse.  I am happy to be somewhere on the healing continuum, and I am summoning all of the patience I have to keep progressing along toward "better".  May I arrive at "best" in due course! 

So, instead of trying to analyze if I'm feeling better or not, I've decided to share that perhaps I've stopped feeling worse.  Although I don't know what tomorrow will bring (does anyone?), it seems that I've had a couple of steady days at this level, with nothing dramatically more uncomfortable.  Weak, tired, nauseous, head-burny, head-pressury, scalp itchy, ears ringing, meh.  And maybe a little bit less grumpy?  Little bit less?  I saw Dr. Oncologist yesterday and she affirmed that I'm doing the right things.  I complained to her about how hard it is to "listen to my body" because I get some mixed messages--my quads want to be used, but my head wants me to stop moving.  She told me to cut myself some slack, and that walking and yoga are perfect for now.  I'll get back up to more strengthening exercises in due course.  I haven't gone in to work in over a week now (work is the most exhausting thing I try to do), and both docs nodded in support of that for now.  I'm only a week out from radiation--the non-Lloyd parts of my brain have lots of healing to do and that takes time and rest!  

When I saw Dr. Radiation Oncologist last week, I mildly complained to him about running out of ways to explain to curious people how my head feels.  He suggested that I have fun with it and create a fanciful story.  So here's what came to mind.  A family of wooly bear caterpillars is camping out in the basal ganglia region of my brain, roasting marshmallows over Lloyd's burning carcass.  The smoke and heat from the fire fills my brain.  Sometimes the fuzziness of the wooly bear family tickles a nerve and makes my forehead or pinkies tingle.  

Dr. Oncologist recently attended the annual breast cancer conference in San Antonio (she goes every year), and she reported to me that we are absolutely on the right treatment path and that my situation is an area of active research because of the high number of patients who are in the same situation that I'm in (I didn't think to ask, but I presume she meant Her2 brain metastases).  She's hopeful for new treatment options in the near future.  Huzzah for being on the right path, and huzzah for new treatments!  

In the meantime, my job is to keep healing.  Next brain MRI is Jan 3; we'll see what's going on inside my head and decide what comes next after that.  The chemo options discussed previously (irinotecan, etc.) will be discussed again after we get further out from radiation.  It's too soon for the chemo options.  My brain needs time to heal!  

I still haven't shaved my head, but TONS of hair has fallen out.  I seem to have bald patches, so it's hard to decide what to do with the remaining hair.  Plus it's not done falling out yet.  BUT I've been slow to decide to shave it because I don't want to if it's not all going to fall out.  At this point I think it's becoming clear that it's all falling out.  Not that there's much left to cut, lol.  Pretty wispy!!  It's mostly just a mess to have long-ish hair falling out, rather than buzzed hair falling out.  I don't know what to do.  One day at a time!  I've been bald twice before; this is no big deal for my vanity.  However, hair is good insulation this time of year.  

The family is doing great.  The spouse and kids chose a beautiful Christmas tree.  It smells so nice!  

A few more from Puerto Rico!  

E sampling from the chocolate fountain at a Gelato shop (Chocolato)

Az reaching out for a cannonball at Castillo San Cristobal.

Spouse and A discussing something important (or possibly discussing our failure to have any quarters with which to turn on the telescope) in one of the WWII era turrets at Castillo San Cristobal. 

E with her cool shades walking through a hallway at Castillo San Cristobal.  

What I'm not doing right now

I'm not walking to radiation treatment right now.  Huzzah!!  It was so hard to remember to go at first: I would be at work, happily working, and then tear myself away and hustle to the clinic.  But now it feels unusual to not have to do it.  I think I'll briefly walk the dog instead.

Thor!  My dad once said that he's the second cutest dog he's ever seen.  I like to taunt Thor about the elusive identity of THE cutest dog, but Thor doesn't seem to take it personally.  Also, don't let this sweet face fool you--Thor is a murderer!  He is a major bunny/squirrel/chipmunk hunter.    

I'm also NOT pulling my hair out (although I kinda am...it's pretty hard not to, because my head is slightly itchy and I was already a hair-toucher).  It doesn't hurt at all, it just comes out.  I'm considering letting the girls cut it off later today, but first it'd be nice to know if it's coming out in patches or all over.  I'm more likely to let them cut it if it's coming out all over.  If it's just patches, I'd rather keep some long hair to cover up the patches.  I had the spouse look at it, and not enough has fallen out for him to determine.  Maybe by the end of the day the situation will have changed.   

I'm also NOT absolutely abiding my diet.  I'm still striving for at least 20 g protein per meal, but I've gotten a little bit lax on the sugar thing.  Some delicious holiday cookies have entered the house, and I am thoroughly enjoying them!  But hopefully not too many of them.  ;)   

Whole-brain radiation--DONE

I received a certificate today for completing two weeks of whole-brain radiation.  Whew!  That was more stressful that I'd anticipated.  I'm feeling pretty glad that the ordeal is over.  I don't think the side effects are done accumulating yet.  My hair started falling out in earnest today, for example, and my head feels burn-y both inside and out, leading to the following one-hit wonder earworm from 1993 (middle school):

This head [bed] is on fire, with passionate love.
The neighbors complain about the noises above.
...
My therapist said not to see her no more
She said you're like a disease, without any cure
She said I'm so obsessed that I'm becoming a bore, oh no.

--band is called James, song is called "Laid"--it's not a very good or appropriate song for a family blog like this one, but it's what happens to be playing in my head ALL THE TIME ever since I thought of the words that my head is on fire.  Which was days ago!  Extra-strength Tylenol helps to quench the flames. 

The other earworm that has been plaguing me is from a save-the-rainforest movie we watched in maybe third grade or so.  K, up in the northwoods, or my multitude of siblings, perhaps you'll remember this with me?  "The RAINforest...the tropical RAINforest."  In my head it has become, "A BRAIN tumor...inoperable BRAIN tumor."  Such a catchy jingle!

The fatigue has situated in the bones a little bit.  Not as bad as chemo, but definitely feeling fatigued in addition to the clinical sleepiness I mentioned before.  It sorta feels like walking around with cinder blocks strapped to your bones.  But I'm doing very well listening to my body and recovering.  Not doing too much at all, I promise.  So much sleep to be had! 

Managing to fit in some holiday family time, too!  My dear friends A&M&E brought us the baked pieces for building and decorating gingerbread houses, so we've been working on those here and there.  Also, before my mom's departure she took us for a spa pedicure.  We now have festive toenails! 

Building the houses is the hardest part!  They needed to harden for a day or two before we decorated.  The girls are having a ball with this project!  Usually when we've done gingerbread houses we've used the hard store-bought kind and then assembled with hot glue, because it's so much easier.  These might be our first authentic gingerbread houses that are actually edible!   

And let's do a few more Puerto Rico vacation photos, shall we?

moon (lower left) over San Juan

E being pushed into shore on her body board

All of my loves enjoying the ocean at Condado Beach.

Over halfway done!

Today will be my 8th of 10 whole-brain radiation treatments.  Just two more to go next week! 

I'm holding up very well, I'd say.  My primary complaints are 1) enormous sleepiness, weariness, and a drained feeling all the time, but it's not the same as the bone-crushing fatigue of chemo so I'll take it; 2) headaches, head pressure, and a fullness inside my left ear; 3) nausea, but I can eat through it, and it is related to the headaches.  If I can reduce the headache, with either sleep or extra-strength Tylenol (the best solutions for me so far), the nausea goes away almost completely.   

Yesterday I saw Dr. Radiation Oncologist, and after I gave him this report he said that he thinks it's the brain-protection drug (memantine) that is causing the profound sleepiness (I've started to refer to myself as "clinically weary") rather than the radiation treatment.  He said that basically, he's sedating me, and that once we're done ramping up to the targeted dose I will probably be able to learn how to work with the side effect.  That's hopeful!  Right now it is overwhelming, and sedated is a good word for how I feel.  I seem to sleep all the time!  And when I'm not sleeping, I'm thinking about how badly I want to sleep, and I feel grumpy quite a bit.  It's not cool.  I don't like being grumpy! 

I'm less grumpy when I'm playing games with the kids.  Perhaps it's because the noise is more organized, less cacophony?  So far we've played Blokus, Concept, Candyland, Tsuro, and the card game War, most of which are excellent puzzle games and of not terribly lengthy duration. 

No hair has fallen out yet.  Dr. Rad Onc said it might be another week before that starts to happen, and even when it does it might be a reverse mohawk on my head and not an all-over baldness situation.  Lol!  So I guess I won't just let the kids shave my head for me, as I was planning to do, because I don't want them to shave it off if I'm not going to lose it all.  Here is a link to the last time I lost my hair, and I let the girls help me with a preemptive haircut.  They were so little!!  They still remember doing this and would LOVE another opportunity.  ;) 

My meditation game has gotten weak, guys, I think due to the clinical sleepiness.  And giving in to the sleepiness feels soooo much better than powering through.  Two nurses now, unprompted, have reminded me to listen to my body, with one saying it's okay to just be tired and lay on the couch, so I'm trying to honor their orders.  And I must admit that I feel much better listening to my body than powering through, so thank you to all of my family, friends, and co-workers for enabling my listening and allowing me to quit powering.   

Shout-out to my mom who is here taking care of my family and me, and we are so grateful!  She's been accompanying me to my innumerable appointments, and she has completely taken over my morning-parent duties of breakfast and walk to school.  She has also been preparing most of our meals and keeping up with our groceries and laundry.  Not to mention the family-elf style projects she has independently undertaken, such as putting all of my too-small clothes in storage so that I have room in my drawers for my steroid clothes.  Thank you so much, Mom!!!  I appreciate you!!  Would that I live long enough to return the services someday (although hopefully it's NOT because you have cancer)!! 

Now for some SCIENCE!  I asked Dr. Rad Onc about the pretty blue light that I see during radiation.  He said that I am seeing Cerenkov radiation!  It is light being generated by the secondary electrons produced by the radiation as they pass through the vitreous fluid of the eye at a speed greater than speed of light through the fluid.  Fancy, speedy electrons!!  Ooo I just love electrons.  This website has a nice picture of the exact color that I see, plus an explanation of why it is blue.  It doesn't just happen inside the heads of people undergoing radiation therapy; nuclear reactors that use water also give off a blue glow.  SCIENCE!!! 

It's begun!!

Oh man, where did we leave off?  Seems like so much has happened since my previous post!

So...I started whole-brain radiation today.  Yes indeed, already.  Getting Lloyd under control without further ado!!  Dr. Radiation Oncologist's office called me yesterday, on a Sunday, at 11:00 am, to tell me that they had completed the radiation plan and were ready to set up an appointment for treatment on Monday, what time would work for me?  After sputtering for awhile, I agreed to take the 11:30 appointment.  It was a somewhat jarring phone call!  Certainly not something I expected after finishing my brunch of egg and mushroom scramble.

The radiation treatment is interesting, albeit a little bit freaky.  Here's how it works:  I lay on the platform, they put the mask over my face/head and have me scoot around a millimeter at a time until I get positioned just right.  Then they move the platform until I'm lined up with some red and green lasers to get the coordinates just right for the treatment, then they take a scan (I think it's a brief CT scan of my head) and tell me that everything has lined up perfectly, and I make a joke about how if I could move the tumor I would have done so a long time ago so of course it's lined up perfectly.  Then they re-position my platform for the radiation.  My hippocampus-sparing radiation plan includes 9 fields of about 30 seconds each, so the whole thing takes about 20 minutes (after factoring in the time for the re-positioning of the table and equipment between fields).  The freaky parts:  1) some of the fields caused me to smell an ozone smell, and 2) some of the fields caused me to see bright, flashing blue light with my eyes closed.  If I opened my eyes, I couldn't see the blue light anymore. Super weird!  My own personal irradiated brain disco party.  Question for B, my bonus mom:  Can you explain the blue light thing?

Delightful part of radiation treatment:  I was treated by one of the dear nurses who took care of me back in the day of my twice-daily chest wall radiation, and she remembered me.  She gave me her arm when she called me from the waiting room, and ceremoniously walked me back to the treatment room.  Also, I had forgotten to take off my glasses, so she removed them from my face, and I apologized that she had to touch the dirty things.  I hadn't properly washed them since Puerto Rico, and the saltwater splatters made them look rather gross, I'm sure.  After treatment, before she handed my glasses back to me, she cleaned them with a proper lens-cleaner towelette.  Then she again gave me her elbow to walk back to the waiting room.  This is above and beyond!  And I'd like to emphasize the power of touch--after a big hug from the spouse, followed by taking the nurse's arm to walk back to the treatment room, I certainly walked a little bit taller and felt a little bit more confident about what I was about to endure.

After radiation treatment I went up to get my blood drawn and have an appointment with Dr. Oncologist.  She presented me with all sorts of great results:  my bloodwork was perfect, my bone scan was all clear, and my PET scan was all clear!  Huzzah huzzah!  No cancer in my body below my brain.  Huzzah!  SO, we are on the correct course of action to control my single pesky tumor (whole-brain radiation) and we'll discuss other Lloyd-control measures after the whole-brain radiation is complete, which will be in 2 weeks--I have treatment every day for 10 business days.  1 day down, 9 to go!

How do I feel now?  Mostly fine.  I have a headache, and I'm tired, but the magnitude of these things is not that much different from yesterday, for example.  My cheeks are kinda hot so I wonder if a fever is coming but I don't feel feverish, and my eyes are very heavy, but let's acknowledge that this was an EPIC day where I had to be all three of my selves (mom-scientist-patient) for at least a few hours each, so it's hard to blame any of these symptoms exclusively on whole-brain radiation.  And yes the part where I was a patient was stressful and hard and seemed to last forever!

My simultaneous tiredness + the need to update my loved ones (you) inspired a new thing, which is blogging from bed.  Thanks to the family elves I now have extra pillows on my bed for proper propping, so I thought I'd give it a shot.  I will definitely not make a habit of this!  I think it would be better and more comfortable and more efficient to simply own the fact that I need to blog/type and then sit in a proper chair with a proper table or lapboard.  This blogging-in-bed thing confuses the two tasks of writing and resting.  And the slow, slipping slouch is a real problem!  I don't know how the laptop-in-bed people do it! 

Time to be done with the blogging and phase-switch into sleeping.  Goodnight!  Be well!  Oh, and it looks like technology is working so I'll leave you with a Puerto Rico picture.  Sigh.  Those were the days!  ;)

The Allens on Condado Beach in San Juan, Puerto Rico, Nov. 2018.

My hair is on the frontlines again

I have previously written about how my hair is the first part of me to know that I have cancer.  Well, sounds like I'll be losing my hair again this time, and it sounds like it might come back or it might not.  Previously irradiated parts of my body have not regrown hair (my armpit was collateral damage in chest-wall radiation--it's half hairless, which is not a bad thing lol), so this might be interesting, but certainly something I can work with.

So, whole brain radiation.  It'll be once per day for 2 weeks, and it could start as soon as Monday but we don't know for sure yet.  Depends on how long it takes the dosimetrist and physicist and radiation oncologist to make the plan, and they'll take their time in order to come up with a plan that is the most protective of the precious parts of my brain that are most in danger by this procedure, namely the hippocampus.  Plus, next week contains a holiday, so there's something tidy about starting the following week.  I'm not in any rush.

The reason for whole-brain radiation and not stereotactic radiosurgery (SRS) again is that SRS is a whopping dose of radiation, and the risk of causing terrible brain damage (high risk of necrosis and stroke) in the brain adjacent to Lloyd is very high if we were to try SRS again.  We know this from patients who have gone before me; thank you brave patients.  Whole-brain radiation is a lower dose of radiation over a much greater area and will hopefully kill off Lloyd's growth for awhile.  Probably not forever, guys.  That's the part of today's consultation that surprised me.  I guess I had been naively thinking that the SRS treatment could and would kill Lloyd forever, and then again that whole-brain treatment could and would kill Lloyd anew, again forever.  I mean, I have no expectation that I'll live forever, but I was clinging to the hope that Lloyd could be controlled and then I'd just be waiting for the next cancer, like I'd been living between the breast cancers.  I suppose in a way that's what this last year has been.  But no, the chance of Lloyd being killed for good by whole-brain radiation is only like 15-30% (the range is because I don't remember what the doc said, and I didn't write it down, but it was something like this.  Less than 40%).  The success rate of SRS was supposed to be 95%, which should have been phenomenal odds...but here I am, with an undead brain tumor that'll kill me in the next 6 months if left untreated, but will still probably kill me in the somewhat near future even if we treat it now in this way.  Ugh.  Time to put that information out of mind!  I've never been a fan of survival statistics, and need to remind myself that I've already done a great job of surviving.

I already told you about the hair loss, but what are the more serious risks of whole-brain radiation?  Well, there is a 40% chance of permanent short term memory loss.  Dr. Radiation Oncologist said that it's not like alzheimers, but it is a nuisance, and it takes awhile for patients to learn to live with it.  Everyone devises their own tricks.  He said that navigation can also become an issue.  He assured me that I'll still be able to work, and that I'll still be able to learn and process things, I just might need to employ some new tricks to get items into longer-term memory storage.  I might need to rely heavily on lists and note taking, for example.  Heck, I already do that.  But in all seriousness, this is when things started to sound a little bit scary to me!  So, thanks in advance for your patience and assistance if this happens to me!!!  Also, thank goodness for smartphones.  It seems that that could make short-term memory loss more bearable, as a helpful tool to make all sorts of lists all the time.  Also, Alexa:  "Hey Alexa, in 20 seconds remind me that the reason I went to the kitchen was to make some tea."  Ha!  Funny not funny.

Bright point #1:  there's a drug that I can take, memantine, which is an alzheimers drug that has been shown to decrease the chance of short-term memory loss in patients like me.  So we're gonna try to get our hands on that little gem.

Bright point #2:  I don't have to increase my steroid dose!  We're going to try to maintain the dose I'm on during the whole-brain radiation and see how I do.  Huzzah!!  I was fully expecting to have to step back up to 12 mgs, if not more (they started me at 24 mgs in January!!).  I'm currently at 2 mgs at breakfast and 1.5 mgs at dinner.  Go me!!!

Bright point #3:  I have to have a new mask made for my whole-brain treatment, and it won't be as tight as the previous mask.  ALSO, it'll prevent me from needing face tattoos (for lining up the treatment the same every time--have have three tiny tattoos from the chest wall radiation, and it's nice that won't need head or face tattoos).  Huzzah!  Mask making will happen tomorrow.

Bright point #4:  The infusions mentioned in my previous post are still on the table, but they won't start until after the radiation treatments.  And I won't know more about that until Monday's appointment.  Huzzah!

Bright point #5:  After my bone scan today, I took the elevator up to the external relations department to learn about how to make a donation to my medical center, as the Allen family pledged to do as a result of the Carnation Nation Appreciation party.  I found out that it's super easy, that we can direct the money to a fund that is designed for patients who need monetary assistance to manage their care (such as gas money, etc.), and that I can give our donation in honor of members of my "care team".  So we can donate in honor of Dr. Oncologist, Dr. Radiation Oncologist, and the nursing teams and support staff, etc., and the Foundation will host a scheduled surprise ceremony for them that my family and I will be invited to attend.  I was very excited by the fact that the donation can be in honor of the people who have kept me alive this long!  This seems like a terrific way to honor them!!  Thank YOU, Carnation Nation, for making this honor possible!   

Bright point #6:  We were in Puerto Rico last weekend!  And it was the BEST!!!  I'll have to post photos some other time because the blog doesn't seem to be accessing my Google albums right now--technology fail.

Bright point #7:  I'm not sure if these folks or their efforts want to be called out on the blog, but you GUYS.  While we were in Puerto Rico, some Family Elves broke into my house, cleaned it, painted two rooms that Ian and I were just barely starting the plan for painting, rearranged the necessary furniture, and did some light redecorating (i.e., new bedspread to match the paint job).  The rooms were the master bedroom and my 9-year-old's (E's) bedroom.  Our flight got home late Monday night, and we walked into BLISS.  It was like an episode of something from HGTV!  The elves even had placed fresh flowers on the dining room table, and breakfast foods in the fridge (we had depleted the groceries before our trip).  AND mulched the leaves in the yard.  AND washed and folded the laundry.  I'm sure I'm forgetting something, but it was seriously unbelievable, especially now considering the somewhat stressful week we're being thrown into.  It was hard to get E to settle down and go to bed, she was soooo excited about her new digs!  THANK YOU, family elves!  You sure do make living with a brain tumor possible, and you make life WORTH LIVING.  I am the luckiest girl!!! 

Bright point #7:  I've found some terrific inspiration from my old self today.  Like here.  I'm grateful to myself for maintaining this blog for so long!  Huzzah!

I found this quotation elsewhere on my blog, when I was looking for something else (I've forgotten what I was looking for, and treatment hasn't even started yet, lol).  Seems like a good day to play it again:

"Why couldn't they just stop complaining so much, just let go and see how good they actually had it?  Everyone seemed to be waiting for something to happen that would allow them to move forward, waiting for some shadowy future moment to begin their lives in earnest." --Lucy Grealy, Autobiography of a Face

I need to make sure I'm not waiting to feel better, or for Lloyd to be good and dead, because perhaps those things won't happen.  I don't think I'm waiting, but this is a good reminder on a day that I have allowed to be a crummy day.  :)   

Short update

We won't have a firm plan for 2 weeks, which is when I see Dr. Oncologist again.  Before then, I will have a PET scan and a bone scan to determine if there is cancer lurking elsewhere in my body.  I don't think there is, and of course I hope that there isn't, but if there IS the good thing about that would be that she could biopsy it and see what its receptors are.  Because we are treating Lloyd in the absence of knowing for sure what its receptors are.  Our assumption is that Lloyd is Her2+ like my breast cancer was, but Lloyd could be something different, or at the very least is quite possibly something different now after being irradiated.  

I will also see Dr. Radiation Oncologist in the next two weeks, and he is one of my favorite Drs. for answering all of my questions.  Although I don't even know what my questions are yet.  What a whirlwind!  

Dr. Oncologist today was terrific, and she has at least 4 possible treatment plans.  She said that she's pretty certain that whole-brain radiation will be a part of my treatment plan to kill Lloyd's slowly growing undead appendage.  She also has some infusion drugs to offer me, including Avastin and irinotecan.  Or possibly some other drug (sounded like "zolata", but google is coming up empty with that) + neratinib, the last of which I'm already taking.  And she had two other combos of these drugs that she mentioned, but she is going to do some more research before making a decision.  ALSO, presuming that Lloyd is still Her2+, she thinks that the neratinib isn't working, so she's not too keen to continue it.  

Now I'm going to leave all of this uncertainty here in the Midwest for a few days and go wiggle my toes in some warm sand.  

Get your affairs in order

I was contacted by someone who wanted to guest-post on my blog in regards to legal documents that a terminally ill patient ought to get in order.  That is a very important issue, and so I agreed to host an article.  Below is the article, which I think contains very helpful information for anyone, really, because no one knows when or how they are going to die.  Please note that this is not an endorsement of any particular company or individual mentioned hereafter.  

5 Essential Legal Documents for Breast Cancer Patients

By Ann Cosimano, ARAG’s General Counsel

When you’re diagnosed with breast cancer, one of the most important things you can do is educate yourself about the legal aspect of health care decisions. You’ll want to make sure you have all the necessary legal documents in place so that your medical wishes are clearly laid out for your medical team and your family.

Sometime in the next few weeks, for Breast Cancer Awareness month, take time to learn about these five legal documents every cancer patient should understand have in place.

1. Health care power of attorney

What is a health care power of attorney?

A health care power of attorney is a document in which you designate an individual – your “agent” – to make medical decisions on behalf of you, the patient. This decision-making power is limited to periods of time when you’re unable to make and communicate decisions on your own.

Why is a health care power of attorney necessary?

Without a designated representative, decision-making authority is determined by state law. This means that treatment and care decisions may be left to groups of people, such as children and siblings, or to individuals with whom you no longer communicate.

What else do I need to know about a health care power of attorney?

Although it may sound like a logical choice, your doctor can’t be your agent. But the person who is designated health care power of attorney can talk with your doctor for medical guidance. The health care power of attorney document only applies when you’re incapable of making and communicating your decisions. When able, you can amend or revoke the power of attorney.

2. HIPAA representative

What is a HIPAA representative?

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that helps protect the privacy of patients. Doctors, hospitals, health care providers and insurance companies are required to follow HIPAA rules. This means they can only share medical information with the patient or the patient’s personal representative, as dictated by this document.

Why is a HIPAA representative necessary?

Without this document, your caregivers may find themselves without access to your medical and insurance information. This is especially true if the caregiver isn’t related to you. When your caregiver can’t access treatment details, it can make patient support for necessary care such as chemotherapy and radiation difficult.

What else do I need to know about a HIPAA representative?

A health care power of attorney is considered a HIPAA authorization, but it’s limited to the periods of time when you’re unable to make and communicate health care decisions. A separate HIPAA authorization ensures access during other situations.

3. Living will

What is a living will?

A living will (also known as an advance directive) details your wishes regarding end-of-life care. This document goes into effect when you are in an end-of-live situation such as having a terminal condition or are permanently unconscious and you’re incapable of making your own decisions.

Why is a living will necessary?

Without a written directive, life-sustaining treatment will continue when you can’t make decisions for yourself — even if the treatment and procedures go against your wishes.

What else do I need to know about living wills?

Each state has its own laws regarding living wills. State laws may allow living wills to include directions on artificially provided food or hydration, end-of-life decisions addressing life-extending or life-saving treatment, pain medication, consent to an autopsy, organ donation and disposition of bodily remains.

4. Durable power of attorney

What is a durable power of attorney?

A durable power of attorney names an individual to manage your financial and personal affairs. This document allows your agent access to financial accounts and gives him or her decision-making authority.

Why is a durable power of attorney necessary?

You might want help managing your finances while you’re receiving treatment or hospitalized. Common needs include access to bank accounts to pay bills and care for children.

What else do I need to know about a durable power of attorney?

There are limits to the authority of this power. Your agent cannot change your will, various types of trusts or designated beneficiaries of life insurance policies and other assets.

5. Last will and testament

What is a last will and testament?

A last will and testament is a document that outlines final directions for who will receive your assets, real estate and personal property when you die. The will also identifies a person (executor) to carry out your orders and a person (guardian) to care for any children under the age of 18.

Why is a last will and testament necessary?

Without a will, state courts will determine what happens to your assets, possessions and children. This is why creating a will is so important — for everyone.

What else do I need to know about last wills and testaments?

A will can be changed and updated as life changes. As children grow or your health improves, the will can either be revised (with an addition called a codicil) or a new will can be created to reflect new situations.

Talking about these vital documents can be difficult. No one wants to focus on worst-case scenarios. But these important legal documents are a way to make sure you are in control and can rest assured that your wishes are followed, no matter what happens.

Ann Cosimano, ARAG’s General Counsel, directs the company's legal, regulatory, compliance and attorney relations departments. ARAG is a leading provider of legal insurance giving people and their family confidence and protection to handle life’s legal issues. ARAG partners with attorneys to provide essential legal services ranging from writing wills to representing clients in a lawsuit. Ann can be reached via e-mail at Ann.Cosimano@ARAGlegal.com.