2 Year Mark: Perspective

As I reach the 2 year mark from when I started my journey with lymphoma, it occurred to me that it’s time for a re-assessment of my travels and the pathways ahead. Although we can’t always see around the bends in the road and the possibility of encountering a deer or a beautiful sunset, we must remain prepared for the possibilities that lay ahead. We may need to slow ourselves down to handle the conditions or gather some speed / strength to muscle up that hill, while other times, the road is clear and straight and it’s nice to just coast in cruise control. At this juncture, I still can’t see around the next curve, but recently, the road has been fairly straight, allowing me to observe the trees and beauty as I proceed.

Nearly every day, someone still asks, “How are you doing? Are you in remission?” The first question is easy. Unless I am ill with a fever, cough, etc. I feel great. I am so grateful for the blessings and life that I have lived and the people in my life that every morning I arise (whether it be at 2:30 or 8 am), I am so happy for the extra time that I have to live life and serve God. Yet, it is the second question that baffles me a bit.

I understand that most people just want to know if I’m currently receiving chemotherapy or lymphoma treatment, for which the answer is, “No.” However, from a medical standpoint, we don’t claim “remission” until someone has gone 5 years without evidence of cancer recurrence. While this sounds definitive, we can never truly know if a stray cancer cell or 2 is active and will choose to manifest itself again, so I prefer the term, “No Evidence of Disease” rather than remission. Honestly, not a day goes by that I don’t think about the possibility of recurrence. This is normal for anyone who has experienced cancer. Likely it is our intuitive drive to stay alive and detect the cancer cells earlier the second time around or maybe it’s a way to feel a little more prepared for what lies around that bend. Either way, it isn’t necessarily an unhealthy state as long as we don’t allow it to distract us from the road we are travelling or miss the beauty surrounding us. Every smiling baby, red-bowed wreath on a doorway, or the intricate design of a bee observed buzzing around a well-lit lamp, will brighten my day.

People inquire if my cancer journey has “made me a better physician,” with more perspective. Well, I think that all experiences enhance our perspective. Certainly, I feel more comfortable talking to others about cancer, treatment options and expectations, since I’ve obtained first-hand knowledge. As for empathy, I definitely feel more connected with people I encounter in all aspects of my life, not just my medical practice. Each one of us is an individual on a different journey, our lives intertwined for reasons which aren’t always obvious. If someone is upset or having a bad day, giving that person the benefit of the doubt comes more easily. They may be struggling with something stress-provoking in their life (whether it be health, financial or relationship issues). In this situation, my job is to ease that stress by remaining positive, complementary or just letting them vent. Being a more forgiving person has brought more joy to my life than I ever anticipated. So, if someone cuts me off on the freeway or grabs the last can of tuna on the shelf, I let it go. I figure that they must need something more than I do, since God has provided so much for me.

What else have I learned in the past 2 years? As my husband and I are empty-nesters, we are perfectly content to just stay home and enjoy each other’s company. We all live such busy lives, particularly when our kids are involved in a multitude of activities, that we often forget the joy of solitude. Don’t get me wrong, we love our family, friends and the festivities we share along the way. But, the drive to travel all over like I desired prior to lymphoma is not nearly as strong. Since I’ve been blessed to see so much of the world already, there are few places remaining to explore that are worth the “pains” of travel. Flying has never been pleasurable for me, but has become more difficult as the check-in process takes longer, my legs swell more and I tend to get jet-lagged much easier. So, long trips to other continents have lost their appeal. Does this mean that I’m officially “old”? Well, I did turn 50 this year. As my husband will attest, I feel better when I am moving, which makes sitting on an airplane for hours quite a challenge. With technology and an infinite amount of video access, I no longer feel the need to actually visit a place to learn and see it well. In fact, I’m noticing diminishing recall after visiting numerous different museums, buildings and landmarks. It’s as if I’m operating a computer with 90% of its hard drive full, I can’t retain as much, nor compute as quickly. I am so thankful that I’ve had the opportunity to meet so many wonderful people from across the world and truly feel connected to a more universal society than just the city or neighborhood in which I reside.

Slowing down no longer feels like defeat. Although I’m still frustrated with my slower running pace and inability to compete at my previous level, it has saved me some money. Now, I only enter races that I enjoy or benefit the community rather than ones that will challenge me or in which I may win my age group. I’m more (not entirely) content with just being able to take a deep breath and run/walk than worrying about achieving my pace. A part of me still longs to run another Boston Marathon, but I’m not yet ready for the dedication, preparation and commitment necessary to qualify again.

All in all, I appreciate every day. No matter the challenges or frustrations, I keep learning from my mistakes, appreciate the gifts God has provided and give my best. I don’t usher out 2017, but I definitely greet 2018 with open arms and welcome the opportunities that lay ahead. God Bless!

"Don't wish it was easier, wish you were better. Don't wish for less problems, wish for more skills. Don't wish for less challenges, wish for more wisdom." ~Jim Rohn

Ice flows along the Chiwawa River

Feeling good, enjoying life...snow may slow me, but can't stop my journey.

My Date with Bacon

The below passage was written yesterday - my preliminary PET scan report from today was normal (no return of the lymphoma). 

It’s been nearly 9 months since my last chemotherapy treatment for Hodgkin’s lymphoma and yet I still live under the umbrella that it could reappear at a moment’s notice.  Calling it a “fear” would be misleading as I do not fear the disease nor the possibility of further treatments or even death.  It is more like that tiny pebble in your shoe.  You feel it’s presence with every step but not enough to stop, in the middle of your run or walk, to remove it.  During the throes of a busy day, the thoughts get moved to the background.  But, in the silence of the night, as you lay down to sleep, every breath or chest tightness brings with it the prospect of a return of the relentless, reproducing cells longing to take over my body.  

Some days my mind still wanders back to those 2 months prior to diagnosis, wondering why I didn’t seek care sooner.  Every symptom, the cough, the fevers, the drenching sweats, difficulty with running, there were alternative explanations for every one of them.  Being of perimenopausal age, sweats and “hot flashes” are common.  Seeing sick people with prolonged coughs, I was sure I contracted the same virus that they had incurred.  Certainly, my running tolerance was either from aging or just being so busy and tired that I couldn’t reach the pace or distances that I was used to achieving.  Yet, multiple times during that 2 month period of time, the thought of lymphoma arose and I just ignored it.  Either my subconscious was more fearful that I would be incorrect in my assessment (an assault to my intellect) or, more likely, it just wasn’t good timing for me to be "sick".  

In November 2015, my daughter was studying in Mannheim, Germany.  She was busily trying to perform skype/phone interviews to land an accounting internship back here in the states while studying, exploring Europe and feeling quite homesick.  Chris and I would skype with her at least twice a week, never really wanting to hang up because we wanted to comfort her as much as we could. The Paris bombings occurred on a weekend when she was traveling to France with a class.  She loved visiting as many busy, German Christmas markets as she could, while we feared that one of these would be the next target.  The Syrian refugee crisis occurred prior to her return, and shortly after she arrived home, several people were killed at a train depot near Koln, where she traveled frequently.  That being said, we worried about her incessantly but didn’t want that known and we certainly didn’t need to add any more concerns at that time.  Then, there was the holidays. Thanksgiving and Christmas were busy, happy times with family that didn’t need to be overshadowed by a gloomy diagnosis.  

Understanding those factors, I have never felt any regrets about waiting to seek care for two months.  The only lingering concern, is that ability to explain away symptoms, and angst that I might delay diagnosis again should symptoms recur.  That being said, I started coughing again in mid-February, shortly after seeing a croupy, 18-month old with an ear infection and lots of wheezing.  Sure enough, I developed low-grade fevers and a miserable, wheezy cough very similar to the cough I experienced with the lymphoma.  After 2 weeks and frequent use of my albuterol inhaler, I started hearing comments from coworkers.  “Are you ok?”  “I haven’t heard you cough like that for more than year.”  In other words, the cough sounded similar to the cough when I was diagnosed with lymphoma.  Although I was pretty certain these were a result to an infectious exposure, my low grade fevers (temperature readings in the 99-100 range) persisted more than 2 weeks and as the cough lingered, I finally gathered the courage to call my oncologist and arrange for blood work and a PET scan.  Of course, within 2 days of arranging these tests, the cough subsided and energy level started to improve (Murphy’s Law).  Along with normal labs, this certainly makes me doubt whether the PET scan is truly necessary, but, alas, I remember having those same doubts the morning I went in to get my chest xray, revealing an impressive number of lymph nodes in my mediastinum.  

Now it is Sunday, the day before my PET scan.  In order to find rapidly reproducing cancer cells, a PET scan uses radioactively-tagged sugar to locate them.  To assure that the cells are “hungry”, you cannot consume any sugar the entire day before the scan and you can’t eat at all on the day of the scan.  

PET scans at my imaging center are only performed on Mondays and Thursdays.  Since my oncologist ordered the “first available” appointment, this landed on Monday, March 6th.  Unfortunately, my schedule was already packed with meetings starting at 7 am, a full day of patients and then ending with a dinner meeting at 5:30 pm.   The 7 and 8 am scan times would interfere with my morning meeting which has already been re-scheduled due to snow and is our first collaboration with physicians from both Overlake and Evergreen hospitals that it’s fairly important that I participate in this meeting.  The only other time availability on Monday was at 1 pm.  Since the test takes about 2.5 hours due to the barium ingestion, lab testing, radioactive contrast administration, and scan time (which is nearly 30 minutes alone), much of this time would be during my lunch hour (since I take a very late lunch).  So, although this meant putting off my coffee and fasting for a longer period of time, this time would inconvenience the least amount of people.  

While eating bacon, eggs, meat and hard cheeses may sound fantastic to some males that I know, I dread this day more than the fasting and scan itself.  I live in the fear that I’ll accidentally mess up and grab a cracker or, in my case, a piece of chocolate and have to reschedule it all over again.  Even worse, we have a grandiose birthday party tonight for my 16 year old twin nieces at a great restaurant in Bellevue and I won’t be able to consume any of the fabulous food or beverages.  In fact, I will be eating beforehand to avoid even the temptation, as most meats are marinated that I have to stick to the deli meat that I found without any sugar.  Even that is a tricky find.  It amazes me how many meat packages contain sugar, even the deli meats typically contain 1-2 g of sugar per serving.  

In addition, no strenuous activity is allowed on the day before the procedure.  Sunday, being the only day that I don’t typically have meetings or work scheduled, is my usual long run day.  This has only amounted to 8-10 miles in the past 2 months, due to increasing fatigue, but it’s still something I enjoy.  My Sunday run is a spiritual time to reflect on the words spoken at church and my own actions and activities for the week.  Which is why I find myself writing.  Just as I journaled during my treatment when I couldn’t run, I will perform the same today.   It is just a different method of reflection for me, but one that allows me to share my innermost thoughts with others.  As a strong believer in God and His guidance in my life, I know that this is His way of re-focusing my energy again to something that may potentially help others, which has always been my purpose on this earth.

No matter the verdict, I endure this small sacrifice, to gain knowledge of my current cancer status.  It will all be worth it for the piece of mind that I am either cancer-free or that I detected the cancer changes much earlier than last time.  Regardless of the outcome, I live with the understanding that this is part of God’s plan to keep me focused on my role and to avoid worrying about the day-to-day inconveniences of this life.  As I continue to give my best and make the most of the talents He has granted me, I must place my faith and trust in Him.  

When you realize God’s purpose for your life isn’t just about you, He will use you in a mighty way. ~ Dr. Tony Evans

The purpose of life is not to be happy.  It is be useful, to be honorable, to be compassionate, to have it make some difference that you have lived, and lived well. ~ Ralph Waldo Emerson

Sample meals for preparing for the PET scan - Egg/cheese/bacon omelet (below) and steak salad with sugar-free Jello (top)

A Day Full of Thanks, A Heart Full of Gratitude

As people across the United States celebrate this Thanksgiving Day, many of us reflect upon the bountiful blessings and people for which we are thankful.  Typically, I perform this ritual on my morning run, although these have been scarce lately since I'm recovering from a broken ankle. However, it's been nearly 9 weeks and I'm back on the treadmill and quite thankful for that today.  Despite the tolls that my body has suffered during this past year, I am thankful that I got cancer.  For all the things that cancer has taken away from me, my bone density (leaving me with osteoporosis and a broken ankle), time away from work (6 months to be exact), and the numerous scars and torn labrum in the shoulder, Cancer has given me so much more.

Throughout chemotherapy, I saw in action, the tremendous heart of my neighborhood, who supported me by providing meals and treats 2-3 times per week.  Neighbors whom I previously would only acknowledge in passing, became best of friends and we still regularly talk, walk and support each other.  I also appreciated the tremendous variety of food delivered that I've learned new recipes and meal ideas to jazz up our mundane recurrent dinner plans.   In addition to fabulous neighbors, I received a considerable number of prayers, thoughts, cards and gifts from patients, friends, colleagues and relatives.  I cannot say enough about how much it brightened my day to hear and see the support of the fantastic people in my life.

Many people have asked if my insight as a patient has made me a better, more empathetic doctor.  Well, I'd like to think that I was always an empathetic physician.  However, the insight that this journey has provided is more that death is less daunting.  Chemotherapy is hard.  I know that through my blogs, I sometimes downplayed the toll that it takes on one's body, but chemo leaches energy, jumbles thoughts and diminishes people's spirit.  While I feel that the Lord protected me, by surrounding me with wonderful people daily, not everyone has that fabulous support system.   If I was 20-30 years older, I don't know that I would have gone through all of this.  So, I respect people more, who choose not to endure chemotherapy.  In addition, I hope to provide support to my friends, family, neighbors and patients when/if they have to go through anything similar.

Most importantly, my heart is filled with tremendous gratitude--not just today, but every day.   While I've always counted my blessings and reflect regularly about all that God has provided in my life (while running), I feel the depth of His love even further after this journey.  I don't sweat the small stuff (as much).  Being cut off by another driver, the scheduling snafus at work, the slowdowns of the computer, or delays at an appointment are just little opportunities to reflect on how bountiful my life truly is.  My heart is filled with gratitude that I'm given another day to share my happiness with others and that rather than getting hit by that car, he just cut me off; rather than leaving that appointment on time and getting caught in an accident or traffic, it allowed me time to figure out a confusing situation; rather than rushing to finish my charts, I'm able to leave a supportive comment on a friend's Facebook post; and that break that was left open because of a scheduling snafu allowed me to see a sick child brought into the clinic instead.

Life isn't predictable, but it is perfectly orchestrated.  God provides us with ample opportunities to shine our light on others and for this I am thankful.  May God bless you all, on this Thanksgiving day, and bring you a heart full of gratitude.


Each day I am thankful for:  Nights that turned into mornings, Friends that turned into family, Dreams that turned into reality, and Likes that turned into love.  

Feeling gratitude and not expressing it is like wrapping a present and not giving it.  ~ William Arthur Ward

Some of the many gifts showered upon me, by friends, patients and coworkers. I am truly blessed and thankful for each and every one of them.  

Moving Forward

Finishing my last 8 ounces of Moviprep has proven more challenging than I anticipated.  Surprisingly, it’s not the urgency to empty that is bothering me. It’s the sheer quantity of  salty-sweet, lime-flavored liquid that must be consumed in a short period of time that is most difficult.  In one hour, you must consume 8 ounces every 15 minutes or roughly 1 liter to achieve the desired effect of a clean colon.  If that’s not enough, you have to repeat it 6 hours before your colonoscopy (for most people that’s within 12 hours).  As advised by friends who’ve imbibed in this syrupy concoction, I used lollipops in between gulps to mask the saltiness.  Unfortunately, you can’t use anything with red or purple coloring however, which left me stuck with lemon or lime (because I already was eating orange jello for “food”, which were too similar to the taste of the prep that I didn’t even bother using those suckers the second time around. This is apparently one of the more gentle and easy preparations for cleansing the bowel for a colonoscopy.  It’s reassuring to know that this is the most difficult component of obtaining a colonoscopy.  As I’ve discovered, with the conscious sedation administered, the procedure itself is a walk in the park.  

Getting the colonoscopy and endoscopy is one of the few steps remaining this year to obtaining a clean bill of health.  Last week, I completed a follow up CT 3 months post-chemo completion and received the happy news of stability.  No new lymph nodes were found and the old, likely sclerosed (scarred) nodes remained at the same size and appearance.  In other words, there are no signs of recurrence of the lymphoma at this time.  By definition, I am in remission (diminution of the seriousness or severity of disease).  Now, is the time to move forward and heal.  

I happily am attempting to resume a full time schedule next week (including Saturday) at work.  While my energy levels have not returned to their pre-lymphoma state, working energizes me.  Since breaking my fibula (the outer bone of the ankle), I haven’t been running, but acquired an under-the-desk elliptical machine to keep me moving (see below).  Since it takes about 6-8 weeks for these types of fractures to heal and I need to tighten the ligaments supporting the ankle, it will likely be another month before I am able to resume my running and start re-building my strength and endurance.  To protect myself from future pathological fractures, I will start on medication to treat osteoporosis.  I am currently scheduled for an infusion of Reclast (a drug to improve bone density) next week .  This will be done in lieu of oral Fosamax due to the irregular findings on my esophagus found during the endoscopy.  After that infusion, I do not foresee any further testing for the remainder of 2016 (said with fingers crossed).  The only exception could be my shoulder, which remains painful despite 3 months of physical therapy.

Getting the clear CT definitely brightened my outlook and is helping me move forward.  Waiting for this ever important checkup, I couldn’t help but play numerous “what if” scenarios through my mind, preparing me for whatever the scan unveiled.  Facing people with new cancer diagnosis or recurrence on a regular basis, was a constant reminder of the reality of cancer and the physical and mental energy that it takes away from living life.  In the quiet of the night or the solitude of being home alone, it is difficult to escape thoughts of recurrence and a new round of grueling treatment. Fearing the unknown often paralyzes us from moving forward.  It distracts us from the dramatic color changes of the fall leaves, the elegantly woven spider web or the joy of seeing a friendly face.  Once those fears abate, we see the sunrise ahead and a fresh start to living begins.  

Sharing my journey isn’t just about cancer and it’s effects on my view of the world, but more a reflection of how to approach any life challenge or disruption.  Whether it be the death of a loved one, an unexpected accident that sidelines you, or a relationship gone bad, life is full of hills and valleys.  As we ride on the roller-coaster of life, keeping our eyes open is the only way to see the beauty and goodness around us, whether it be directly in front of us, by our side or off in the distance.  Closing your eyes, may block out the unpleasant, but doesn’t allow you to enjoy the attraction.  Some rides will be painful or nauseating, while others may invigorate you or provide a view that you’ll never forget.  Whatever road you may be traveling, it’s always more enjoyable when shared with another, whether it be a spouse, friend, family member, or God.  This companion provides a different perspective along the way and the support necessary to keep moving and embracing other potentially exhilarating rides.  Life is a roller coaster, you can either scream every time you hit a bump, or throw your hands up in the air and enjoy it.  

Scream through the peaks,

Hold hands through the dips,

Laugh through the loops,

And enjoy every twist and turn.  

My under the desk elliptical

Running Away

It’s amazing how many life changes can occur in just a couple weeks.  2-3 weeks ago, I was lamenting my surprise over the discovery that I have osteoporosis and the ongoing struggles and accelerated aging incurred through chemotherapy.  Well, like a bad horror film, just when I started seeing the light at the edge of the woods, the osteoporosis came to haunt me.  

One of my partners and I attended a conference in Florida a couple weeks ago and on the last day of the conference, they celebrate with a 5K run.  Although I was signed up to run a 10K for lymphoma research the following day (in Washington), I convinced my partner to walk the run and I would run it at 6:30 am on our last day in Florida.  The weather was balmy (73 degrees and 90% humidity).  Given the conditions, there was no fear of sore muscles and ideal weather for a short race like this one.  The race started well and I felt a steady rhythm and nice even pace.  After passing the water stop at the 1 mile point, I found myself in a small group and the second place woman in a field of nearly 100 people.  Turning the corner, heading in to the second lap, my right foot pushed off and my left foot landed on the pavement with a singe of pain.  For no apparent reason, my ankle twisted beneath me and as I attempted to push forward, I felt a crack.  Runners passing by encouraged me to, “Walk it off,” to no avail.  I knew as soon as I couldn’t put my full weight on my left foot, that this was no sprain.  For the first time in my life, I DNF’d (did not finish) a race.  I hobbled my way back to the hotel for a shower and donned my compression stockings as soon as possible (to minimize the swelling).  

With ice in tote, from the hotel ice machine, we worked our way across the street to the conference.  Using elevators, escalators and toe tapping, I managed to make it through the conference and onto the plane at the airport.  While in flight, my compression stockings did the trick of minimizing the swelling.   However, finding a method of removing my compression hose without moving the ankle was quite a struggle, even with the assistance of my husband, and took nearly 10 minutes as I inched them over the broken bone, wincing in pain.  Nonetheless, I managed to eek out a few hours of sleep before arising to walk with friends the following day.  Wearing an aircast stabilized the ankle, and the swelling provided the cushion necessary, to hobble around until I was able to xray the foot the following day.  

Xrays revealed the fractured fibula associated with the sprained ligaments.  A boot was placed and with crutches and a scooter, donated by friends, I was able to get around (albeit very slowly).  As this was my first week back to a nearly full schedule and my first Saturday of 2016, it was a rough week to be restricted.  Between the broken foot and obtaining the flu and pneumonia vaccines, my fatigue level increased even further.  Keeping my eyes open during lunch was a challenge, but I managed to make it through the week with the helpfulness of a fabulous medical assistant and wonderful coworkers.  

The foot is healing well now and I’m learning the struggles of those with mobility issues.  Scooters don’t do well on the crooked, uneven streets of Bothell.  You feel every bump, groove or crack and wheels seem to always find the grooves causing them to turn in an instant.   Descending stairs boot first has nearly led to a comical face plant.  Stairs are best navigated walking backwards. Crutches, too, are quite challenging on stairs or going down hills or slopes.  If you walk too rapidly, falling is inevitable.  Fortunately, my shoulder had improved well enough that I could navigate crutches (God never gives us more than we can handle!)  Nonetheless, I’m sure I looked like a Miley Cyrus song, “...she came in like a wrecking ball.”  In the long run, I greater appreciate the frustrations of mobility disabilities and understand the importance of ramps, handicap parking permits and automated doors to help people remain independent whilst struggling with mobility.  

Once again, my running has been sidelined.  With this challenge, as with every adversity, I try to understand what message God may be trying to relay.  During chemotherapy, when I was unable to run, I used writing as my release, in lieu of running. As multiple patients have commented about my writing these past 2 weeks, I pondered, “Is this God’s way of telling me to get writing again?”  Of course, it would be much easier, if He would just whisper in my ear, rather than breaking my foot.  Yet, I’m obviously a slow learner and so He works in multiple ways to communicate His message.  For the next 3 weeks, I will avert my running and focus my energy on other projects, which I had once again, placed on the backburner after returning to work.  Balance is key, both in walking and in leading a fulfilling life.  My rehabilitation process will include discerning ways to improve my balance.   

For those wondering about the title of my blog....I first titled it running away because I've been forced to stop running and thus put it "away" for now. But, as I contemplated further, I realized, it really relates more to "running away" from God's plan that He relayed during my chemotherapy down time. As I returned to work, I jumped right back into old habits, rather than incorporating changes for a more balanced lifestyle. Although I was enlightened with a greater perspective through cancer, I failed to take what I learned and apply it. Old habits are hard to break, unlike osteoporotic bones. The moral is that we need to listen and learn to modify our approach sometimes in order to obtain better outcomes in the long run.

They always say time changes things, but you actually have to change them yourself. ~ Andy Warhol

One reason people are resistant to change is because they focus on what they have to give up, instead of what they have to gain. ~ Rick Godwin

One week later, swelling has decreased but bruising more visible (settled near toes). 

The Aging Dilemma

It was inevitable.  Since returning to work 2 months ago, I’ve mostly been catching up on physical exams and seeing just a few acute care visits daily.  But, as I’ve extended my work hours, my schedule includes more of my delightful pediatric patients and their acute illnesses.  While it’s wonderful to see the beautiful smiling faces of infants and toddlers, it’s fairly easy to acquire whatever germs they carry as they cough in your face or place their fingers and hands on you and your equipment.  That being said, there’s been an epidemic of gastroenteritis (i.e. diarrhea) running around the community, even resulting in beach and restaurant closures, that it was only a matter of time before I received my exposure at work.  Fortunately, the test of my immune system was short-lived.  Less than 24 hours after my fever and GI distress started, it had abated. While uncomfortable, I was determined that with adequate fluids and GI rest (no eating), I could push through this inconvenience, and fortunately, my body cooperated.  

So, what does this poopy story have to do with aging?  If it weren’t for my body’s years of experience and exposures in the medical field, this illness could have kept me out of work for days or weeks.  Through my years of experience, my body has generated a vast array of antibodies.  These antibodies are the difference between my less than 24 hour recovery from an illness that generally takes a toddler 1-2 weeks to overcome.   It’s so easy to look at the negatives that come along with aging.  The bones and joints are stiffer, we don’t heal as easily from injury, more and more of our friends and relatives are dying or getting diagnosed with terrible diseases and the list goes on. However, as with everything, I challenge you to look for the positives.  

With age comes experience and wisdom.  Although many employers value youth and originality over experience and wisdom, wisdom is what keeps us out of trouble.  Just as the toddler learns that putting a metal key in an electrical socket will burn you, our experiences help us develop wiser decisions that keep us safe.  Eventually, this leads to less anxiety and a more fulfilling life.   We no longer look toward objects, money or that latest fashion to provide our happiness, but rather enjoy reading an enlightening novel, watching a funny movie or just holding the hand of a loved one.   It’s often said that we “slow down” as we age.  While for the young, that may sound boring or unappealing, it really isn’t a negative.  As we slow down, we see things that would have otherwise passed without notice.  The hummingbird chirping from the cedar tree, the gorgeous dahlia hidden aside the thorny rose bush and the toddler giggling as he chases after bubbles being blown by his father.  Every moment of every day, shapes our life.  We can either choose to walk by quickly on our way to Starbucks or stop and smell the roses, invigorating our senses along the way.  We can be that runner in the Olympics stopping to help their fellow runner who tripped, and develop a lifelong friendship and bond that is honored by the world, or we can choose to continue in the race for our own personal record.  

There is beauty in slowing down.  There is beauty in aging.  Although I’m still in my 40’s (albeit not for much longer), my mother is in her 80’s and I have 3 siblings turning 60 in the next 2 years (yes, I had 3 brothers who are less than 2 years apart...busy mama).  The toll of chemotherapy on my body does make me feel much older than I am (I feel as if I’ve aged 10 years in the past 6 months).  Yet, I will embrace the grey hair, my osteoporotic bones and the aches and pains of aging, to be granted a new outlook on life.  I feel blessed every day to take a deep breath, feel the raindrops on my skin, the smell and taste of fresh coffee as it glides over my tongue and the love in my heart from all the beautiful people in my life.  I can’t help but start each day with a smile, no matter how upset my stomach is, how much my shoulder hurts or how little sleep I got the night before.   Life is a blessing and aging is a privilege.  

In past blogs, I’ve included the Serenity Prayer.  In this blog, I’ll include the Senility Prayer:

God grant me the senility...

To forget the people I never liked anyway,

The good fortune to run into the ones I do,

And the eyesight to tell the difference.  

Aging is not lost youth, but a new stage of opportunity and strength.
~ Betty Friedan

Embracing the gray and the new hair coming in. 

One step forward, two steps back

There has been an interesting turn in events over the past week, that once again, has encouraged me to evaluate purpose and lifestyle.  After returning to work, over a month ago now, I’ve been able to gradually increase my hours and appreciate the return to a normal schedule.  Time spent collaborating with patients, colleagues and coworkers has ignited a fire inside and is keeping me warm and inspired.  Although I still feel frustration when the computer randomly knocks me out of our EMR (electronic medical records) or the mice inside the computer appear to be churning molasses, I am still invigorated by the love surrounding me in friends, family and patients.  

Unfortunately, life isn’t just sunshine and rainbows.  With a massive fire displacing our administration and business office personnel, we’ve had to accommodate and be flexible with adding more people to the office and changing workflows.  And yet, positivity has remained elevated. People have been accommodating and in some ways, we’ve pulled closer together as an organization, getting to know each other better.  Like the phoenix, we will fly out of the ashes, more united and beautiful than ever.

The downtown Bothell fire - July 22, 2016

Concurrently, I’ve been attending physical therapy to restore strength and decrease the aching pain that lingers in my right arm and shoulder.  While I’ve been working hard for the past month, doing my home exercises, regaining more range of motion, the pain has worsened.  At my last evaluation (before obtaining insurance approval for more therapy), the therapist noticed my scapula winging (displaced in comparison to the other shoulder), something I couldn’t see because it’s behind me.  After further assessment, the therapist suspects a long thoracic nerve injury.  While daunting, this diagnosis fits the symptoms, the mechanism of injury (surgery and port placement) and reasoning behind my increased pain and yet persistent weakness.  Unfortunately, the prognosis is a 1-3 year recovery (if at all).  In the interim, my surrounding shoulder muscles must learn to stabilize the joint, which keeps gliding in and out, creating the muscle spasms that deter me from sleeping.  When the pain intensifies, I must use my left arm to glide my right arm into position, so I can raise a stethoscope or reach overhead.  While attempting to bowl with the kids, a week ago, I lifted my 14 pound bowling ball, temporarily forgetting about my weakness, and as soon as I lowered my arm, the ball went flying onto the floor.  Of course, it led to a few chuckles, but magnified the realization that there are activities that I just can’t perform at this time.  It was a daunting reminder to appreciate the small things in life.  The ability to lift a mug or walk a mile are daily activities that we often take for granted.  And yet, for many, these feats are major hurdles.  And so, I’m channeling my inner left-handedness (which Chris is enjoying) and count my blessings for the great many things that I can accomplish.  

If that setback wasn’t enough, I learned on Friday, that I have joined the ranks of many octogenarians with the diagnosis of osteoporosis.  If that comes as a shock to you, you can only imagine how shocking this was for me.  While I knew that chemotherapy and its induction of menopause would worsen my bone density, I generally prided myself in the fact that I’ve been a good milk drinker, eat healthy, perform a great deal of weight-bearing exercise and have excellent genetics that these strengths would protect me from this formidable diagnosis.  In fact, I scoffed at the idea of even performing a dexa (bone-density) scan when my oncologist suggested it, as certainly the pounding of greater than 10 years of running 40-50 miles per week would leave me with bones of steel.  With the encouragement of my wise primary care provider (always listen to your family physician), I reluctantly agreed to evaluate my bone density.  And now, unfortunately, we need to determine how to treat it.  

While I don’t plan to jump out any airplanes, I worry about downhill skiing or other physical activities I enjoy.   Since the majority of my bone thinning is in the spine, my biggest threat will be a compression fracture.  I’ve seen the pain from compression fractures, the height loss and how modifying life can become after a fracture and I want nothing to do with that.  I’m too young to restrict the activities I enjoy.  So, I will take hormones, bone building medications, calcium/vitamin D and whatever it takes to strengthen those bones once again.

My other major challenge has been the pitting edema (swelling) in my legs (see picture).

Fingerprints in my leg show the degree of swelling

 While this is more of a nuisance than a limitation, the heat has not been helpful.  After standing or sitting all day at work, my feet become so puffy and painful that I look forward to taking off my shoes and sitting in trendelenburg on the recliner (elevating my feet).  It would be nice if I could just poke my feet, like a balloon, to let all the fluid release, but unfortunately, that would just leave me looking like a fat pin cushion.  Wearing compression socks and hose is helpful, but can be a struggle to don on and off and they aren’t exactly fashionable or comfortable in the hot weather either.  I’m sure I’ll do better with the compression attire in the winter and fall months.  

Although grappling with my physical challenges and limitations has been frustrating, as it’s such a deviation from a year ago, each day, I remind myself how lucky I am to live, laugh and run.  As a physician, I know that I can’t “fix” every problem and sometimes my role is solely to help people understand what is going on in their body and learn how to most comfortably live with the maladies that we cannot mend.  As aggravating as cancer and chemotherapy can be, I am thankful that I survived it and I’m thankful that I’m able to return to a profession that provides me with so much joy, challenges my brain and produces rewarding relationships that generate so much empathy, love and support.  In posting a happy birthday wish for my niece, I perused through my pictures trying to find the perfect one(s) for her.  The sheer number of joyous pictures and memories that I’ve accumulated over the years, with so many different people, reminds me of all the blessings that God has given me.  My challenges are just a drop in the bucket of a life filled with so many great people, adventurous journeys, beautiful surroundings and so many positives that I refuse to be distracted by the bumps along the way.  My greatest strength will arise from my ability to overcome my weaknesses.

The greater the obstacle, the more glory in overcoming it. ~ Moliere

Challenges are what make life interesting and overcoming them is what makes life meaningful. ~ Joshua J. Marine