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

Getting in the Groove

It’s been 2 weeks since I returned to the workforce and 3 weeks since my port was removed.  While life is taking on a more rapid pace again, I’m trying to slow the pace and stay on course with balancing my physical, emotional and spiritual well being.  Allocation of time and priorities have changed, leading to less time on social media, blogging and reading.  Coffee consumption has increased, along with my blood pressure (at least there are good medications to control this).  Yet, I find my career more fulfilling and rewarding as ever.  Perspective has improved, making the “little things” less stressful while maintaining focused on the present and the gifts, rewards and beauty surrounding us in nature, the people we encounter, and the challenges that we accept and fulfill.

Unemployed people returning to the workforce likely recognize the value of routine better than anyone.  As I find myself arising at 6 am and attempting my previous routine of running before work (which has only happened a few times), I notice that my muscles are stiffer when I awaken, my goopy eyes take longer to focus and in general, I am more sluggish.  Once I get outside, I’m sure the neighbors assume the zombie invasion has started, as I take those first few stiff steps as my muscles are still tight, sore and fatigued.  Along the course, I hope to gain some flexibility and lose some of my rigidity, and if that occurs, I will stretch my run into a 5 mile jaunt, and if it doesn’t, I stick with a 2 or 3 mile run/walk.  Either way, it’s rejuvenating to be outside, especially if it’s sunny.  I enjoy every breath of fresh air travelling through my lungs, the wild rabbits scurrying to hide, the birds chirping as if calling to their lover and the friendly smiles of neighbors passing by.  When you live in the present, instead of always looking at the future, everything seems more alive, enriching and fulfilling.  

Starting with a new, young, but experienced, medical assistant (MA), I try to arrive in the office 30 minutes before the first patient arrives, which means 8:30 am.  I admit, “I try!”  More often than not, it is 8:45-8:50, but so far, I have always arrived before my first patient.  My first 6 days of work, I saw patients for 4 hours/day.  Shockingly (to me, at least), by 2 p.m., I found myself exhausted and nodding off while eating lunch.   I’d struggle to complete the days’ charts, correspondence and paperwork before heading home, but usually found myself leaving for a nap and attempting to finish my work in the evening instead.  As my schedule started filling up, I found myself yearning to see more of my clients as I noticed them popping up on other provider’s schedules.  So, I added another hour to my afternoon schedule and extended to about four in the afternoon.  The first couple of days of this, I struggled, as my sleep pattern (or lack thereof), at night, was still terrible.  With multiple awakenings and the persistent joint achiness, I found my energy level still low.  Yet, adding the hours, didn’t seem to make it worse.  In fact, I think the elimination of the afternoon nap has actually improved my energy level in the long run.

As I am re-learning the EMR and developing operational efficiencies with my new MA, my end of day workload is gradually diminishing.  Not only does it take time to establish a fluent workflow, but developing a team strategy evolves methodically, as you learn each other’s strengths and weaknesses.  One of mine, of course, is the desire to catch up on the lives of all my patients!  

If you had asked me a week ago, “how’s it going?”  I might have responded, “a little slower than I expected.”  However, I’m finally noticing many of my residual chemotherapy symptoms, starting to fade.  Two weeks ago, I felt like my body was perpetually battling the flu with constant hot flashes, sweats, achiness and a generally ill feeling.  I tried multiple medications to help diminish these symptoms and generate restful sleep.  None of these “remedies” quite helped as much as the passage of time, which is why I suspect they were persistent manifestations of chemotherapy. The nerve pain, shooting down my arm, resolved within days of removing my port.  However, the recovery of my strength, range of motion and pain from disuse, will take time, with the help of home exercises and physical therapy.  Once again, requiring my most elusive trait, patience.  

Although I could write more about how elated I am to return to my vocation, I will leave you with these words from Maya Angelou:  “Success is liking yourself, liking what you do, and liking how you do it.”  While I’ve got 1 and 2 down pat, #3 is a work in progress.  I’ve had 6 months to evaluate the way I do things and I suspect I will continue learning this for the remainder of my life.  Yet, in returning to work, I’ve learned that in order to “like the way I do things”, I must: (1) avoid staying up late and losing sleep, (2) balance my family life better (drawing boundaries and remaining in the present, rather than always thinking of my “to do” list), (3) maintain perspective (seeing the good, even in bad situations or frustrations) and (4) spend time reflecting on what’s working and what’s not and eliminate the aspects of my life that are not adding value or interfere with my accomplishment of 1, 2 and 3.  Life is too short to let frustration, anger or discontent run me down further.  I choose to live with a heart full of beauty, love and happiness and it starts with me and my perspective.  

What lies before us and what lies behind us are small matters, compared to what lies within us. ~ Henry David Thoreau

Perspective is everything. Looking at a field of dandelions, you can either see a hundred weeds or a thousand wishes. One small positive thought in the morning, can change your whole day.

The Future - PET Scan Results

What does the future hold?  None of us really knows the answer to that question.  All our life we spend planning for our future and anticipating that first driver’s license at 16, sip of alcohol at 21 (ok, I know many of you started before 21), buying a car, buying a house, having children and eventually retiring.  Along the way, we imagine the joys that each of these feats will hold.  We don’t think about the potential car accident, the agonizing hangover, sleepless nights with a newborn or broken pipes in the home.   When we look to the future, we generally anticipate happiness, not sorrow.  It is with hopeful anticipation that we approach each day.  

After 14 hours of limited carbs (only from my spinach and broccoli) followed by a 12 hour fast, I eagerly guzzled my 450 ml (approximately 15 ounces) of fruity-flavored, but gritty barium.  15 minutes later, I was escorted to a brightly lit, small dressing room warmed to 76 degrees by a space heater.  It pleased me to see the familiar 30-year old technician that had performed my previous 2 PET scans.  After the usual confirmatory data, he updated me about his 16 month old child and goals for him and his wife to move to New Mexico (where his family resides).  I pointed out my bulging veins from which to draw blood, but of course, talking about veins always scares them away.  Although the first attempt failed, leaving a small bruise in its place, switching to the other arm provided good venous return to obtain my blood sugar and then place an IV for my radioactive tagged glucose to look at metabolic activity in my body.  

About 50 minutes after injection of the radiotracer, I am transferred to the scanning room where I must lay on my back with my arms above my head for nearly 20 minutes.  Similar to the no carbohydrate diet, this is the most painful part (for me) of obtaining a PET scan.   Roughly 3 months ago, I started experiencing shoulder and arm pain, so I didn’t have this pain with my first PET scan.  We performed an ultrasound of my arm at that time, to assess for a blood clot.  Since the pain was intermittent and often associated with shooting nerve pain and hand/arm swelling, we assumed the pain originated from the port pushing on the nerve, vein and artery bundle (particularly since it often worsened while laying down to sleep at night).  Fortunately, the nerve pain has subsided since removing the port, but I suspect my ligaments partially calcified, due to decreasing my use of the arm, which in turn, created more pain with certain movements.  At least this is fixable with exercises and physical therapy.

Twenty minutes later, the whirring of the CT scanner machine ceased and the table slid me out of the tube.  Thankful to finally be able to move my arm, I gathered my purse and belongings and sauntered to the lobby to drink coffee, which the imaging center thankfully supplies, and my Reeses peanut butter sticks hidden in my purse.  Later, the tech returned to the lobby with a CD loaded with my images and I headed to the car to enjoy my hot bacon laying on the dashboard (in a Ziploc bag). It tasted so flavorful.

Knowing my future plans were pending the results of this scan, I was eager to hear the results.  But, PET scans are not easy to read and I would await the professional opinion of the radiologist before making any interpretations of my own.  Although I received the dictated report later that evening, they never say, “everything is clear of cancer” or “no abnormal findings found.”   Unfortunately, once you’ve had bulky disease and surgery, there’s bound to be residual debris and scarring, making subsequent scan readings more difficult.  I would have to await my appointment the following day to learn my fate.

Chris came with me to my appointment with the oncologist.  As usual, she came in with a smile on her face and asked if I had seen the report.  “Of course,” I answered, “but I’m interested in your opinion.”  Luckily, she had reviewed the images with one of our favorite, meticulous radiologists who felt that the scan looked good and similar to the scan taken mid-treatment.  The remaining lymph nodes were much smaller, less active and likely just residual frames of their cancer-filled shells. There were a couple of “new spots” or nodes but they were small and considered likely inflammatory.  Given their small size, we will just keep an eye on them and recheck a CT scan in 3 months (NOT A PET SCAN!)  Of course, if they are bigger, then I’ll probably have to get a PET scan (but, if possible, I’ll vote for a biopsy instead).  

In a nutshell, results were good and I will not be undergoing any further lymphoma treatment between now and October.  My goal will be to gradually increase my stamina to a full-time schedule at work and regain the strength in my muscles, eradicate or learn to tolerate the hot flashes, and rehabilitate my right arm to full functional capacity.  All of this, while maintaining my sanity, wit, perspective and hopefully, blog! I can’t thank you all enough for all the positive thoughts and prayers.  I truly believe that God listens, and the abundance of support certainly lifted my spirits, making this journey more of a blessing than a curse.  

Stop waiting for Friday, for summer, for someone to fall in love with you, for life. Happiness is achieved when you stop waiting and make the most of the moment you're in right now.

It is good to have an end to journey towards, but it is the journey that matters, in the end. ~ Ursula LeGuin

Bacon sizzling on the dash (to eat after the scan) & chalky barium to drink, for the PET scan.

Returning to Work

Monday came and went in a flash.  Once again, my mind struggled to fall back to sleep after a 5:00 am hot flash and my body wrestled its way out of bed to attempt a run before heading into the office for the first time in over 6 months.  Normally, I would have suspected the anticipation and excitement of returning to work to produce my early arousal, but the cumulative effect of sleep deprivation over the 3 days prior, prompted a quick onset to sleep.  Nope, it’s still the drenching sweats, arm swelling and joint pains that awaken me, despite the cessation of chemo and my port removal.  Knowing that I was only working a ½ day alleviated my fears of losing steam before seeing my last patient of the day.  Yet, I was eager to see my colleagues, coworkers and patients again and looked forward to the challenging puzzles and decisions that would come my way during the day.

After a quick stop at Starbucks for a grande flat white with 3 shots of ristretto (a concentrated espresso shot), I figured I could make it at least 6 hours.  When I walked through the double set of doors, I laid eyes on the beautiful decorations and posters that welcomed me back.  To my left, sat my new medical assistant, who arrived well before me and had already taken care of a couple of phone calls that managed their way to my desktop.  After an hour of re-training, I was back to work, doing what I love and missed so much.  

It was a relief to step back into the pace of work and see so many familiar faces. Without a doubt, though, I was tired by the end of my 4 hours of seeing patients.  Before I could even finish all my work, I headed home for a two hour nap (both Monday and Tuesday).  It’s clear to me that my biggest struggle in the upcoming weeks will be battling the fatigue.  Prior to lymphoma settling into my chest, I was running 40-50 miles per week and my typical day started at 6-6:30 am with an hour run and then I’d see patients from 8 or 9 am until 6 pm.  I’d usually take another 1-2 hours to address phone messages left throughout the day and prescription refills.  Then, I would go home, grab a quick dinner and settle in my home office to finish up loose ends and review electronic correspondence from other providers, lab and imaging results and address any internal flags (messages from coworkers) or emails.  Most days I would work until 11 pm - midnight and attend to any non-urgent work the following day or on the weekend.  I can’t even fathom accomplishing that routine at this time.  

If I were to estimate my energy level compared to when I was able to perform the above routine, I would suspect I currently have about 40-50% of my previous energy level.  Both days that I worked this week, I attempted a run and didn’t reach more than a mile before settling into a walk and although I set out to run just 3 miles, I was only able to complete a 2 mile walk/run.  While I saw patients for only 4 hours, I was exhausted.  My body required a nap when I returned home and despite the mid-afternoon nap, I had difficulty keeping my eyes open past 8 o’clock.  The cumulative effects of interrupted sleep summoned me to bed like the cries of a baby calling for its mother.

While I am frustrated with my lethargy, I am thrilled with being able to return to a career that stimulates my mind, utilizes my skills and provides the opportunity to help others.  I’m hopeful that I will strengthen over the next several months and will continue to actively strive towards regaining my agility and abilities. I may never run another marathon (and that doesn’t sadden me), but I’d like to be able to open bottles and lids more easily and arise from a squatting position without having to hold onto a chair or grab a counter.  I’d also like to dump the mid-day naps and sleep a full 6-7 hours at night, without awakening.  Yet, despite it all, I am alive.  I smell the fresh air in the morning and hear the birds chirping outside my window, which fills me with joy.  I get to hear the laughter of my children, watch the Mariners pull out another walk-off homerun win and celebrate birthdays & weddings with friends and family.  Life is a blessing and each day is a gift from God.  I will do my best to make the most of each day that I’m granted.

Pleasure in the job, puts perfection in the work. ~ Aristotle

ABILITY is what you're capable of doing, MOTIVATION determines what you do, and ATTITUDE determines how well you do it. ~ Anonymous

Two different patients brought these gorgeous pink roses on my first day back.  

Getting Ready – Port Removal

A glance at the alarm clock told me it was 5:30 am.  Unable to get comfortable, I decided to arise.  Upon heading to the bathroom to grab a cold drink of water, I decided to quit fighting the sleep and just get ready for the day.  It was not the anticipation that awakened me throughout the night, but the increase in swelling and throbbing in my right arm.  The port in my right upper chest needed to go.  Finally, today was the day. 

In order to arrive on time for my port removal, we needed to leave by 7:40 am, so obviously I was awake plenty early.  My first decision for the day was determining what to wear.  Assuming they would make me take, “everything off from the waist up,” I didn’t worry about what I wore on top, as I’d be enrobed in their lovely, fashionable patient gown.  But, with the hot flashes, I needed to be sure not to dress too warmly, in case they had me draped (covered) during the procedure.  The last thing they (or I) needed was me sweating profusely while they are trying to suture or apply dermabond (glue to close the incision).  So, I settled half way between pants and shorts and wore capris, which covered my legs to just below the knees.  After dressing, I realized that my legs weren’t recently shaved.  I’ve always wondered, “Do men worry about shaving their face as much as women worry about their legs?”  Of course, a 5 o’clock shadow in a man, is admired by many women.  The next thought was, “Why am I continuing to lose hair on my head while my legs continue to grow hair at the same pace, if not faster, than usual?”  Doubtful that I would figure those answers out today, I proceeded downstairs to find Chris washing dishes (if you haven’t learned already, he’s nocturnal and that’s why he falls asleep so easily during daylight hours).

Chris wished to tag along, in hopes that he could observe the procedure (of course, I secretively hoped he would video record it).  I’ll admit, we’re both science nerds and love to watch medical shows and continually learn about science, medicine and technology.  Sometimes we wonder how we ended up with 2 kids that can’t stomach it at all (one even faints during movies that imply blood or pain).   

After circling the parking lot to find a spot, which is odd considering I even have a physician parking permit, we finally found one that wasn’t a compact (so our car wouldn’t get dinged when opening the door).  We hustled to diagnostic imaging and then waited in line for 10 minutes to check-in.  After being asked if my procedure was related to an injury (hmm…not that I’m aware of, but I was asleep when it was placed), we sat in the quiet lobby, with its brightly lit, colorful fish tank, and waited to be summoned. 

When my name was called, Chris and I rose to leave the area.  Unfortunately, the delightful assistant informed Chris that he could not observe the removal of my port, as it occurs in a sterile operating suite.  This surprised me, as the Youtube videos that I viewed showed minimally sterile technique, in an office setting.  Yet, I wouldn’t argue with them being more cautious since my white blood cell count (WBC) is still at half of the lower limit of the normal range (placing me at higher risk for infection).  Nonetheless, I was taken to a generic women’s dressing room, thankful that there was only one other person present (less explaining to do).  Within 5 minutes of changing into my lovely blue, faded gown, I was escorted to the operating suite down the hall.

Upon arriving at the diagnostic imaging suite, I was greeted by a humorous, outgoing, dark-skinned male (we’ll call him John) and a petite, gray-haired, fair-skinned woman.  These two would be helping the physician assistant (PA) during the procedure.  John was very polite and cracked jokes about what type of doctor I was, hoping that I could perform bariatric surgery on him.  I replied with my best winky-eyed face, “No, but I’d be happy to help with diet and exercise changes.” Meanwhile, the other assistant discussed my allergies and when I informed her of my adhesive allergy, she showed me the tegaderm-like bandage that they utilize and I retorted, “Well, I’ll know within 30 seconds whether I’m allergic to it or not.”  After informing them that the SCCA (Seattle Cancer Care Alliance) uses a bandage that doesn’t cause me to break out in hives, the assistant ran down to SCCA and picked up the special IV 3000 orange bandage. 

In order to avoid the gore that grosses my children out so much, I won’t dive into the details of the procedure--you can watch a Youtube video if you’d like to see it.  They draped me from head to toe, so I couldn’t watch (bummer).  While the PA was tugging on the hardware to grab the sutures holding it in place, I noticed that I wasn’t completely numb in certain areas.  When he infiltrated the area with lidocaine, nerve pain shot into my shoulder blade and down my arm, just like the pain I’ve been encountering intermittently over the past 2 months.  As irritating as that knife-like jabbing felt, it excited me.  I felt encouraged, that indeed the port may be the cause of my arm pain, since it lay directly on that nerve.  Of course, the swelling that ensued after the removal and the fact that the cavity created would eventually fill, left me with some concerns regarding persistent pain, especially if scar tissue decides to inhabit the region.   Nonetheless, this procedure brought me one step closer to returning to work and to the life I previously knew well.  

Before everything else, getting ready is the secret of success. ~ Henry Ford

   Picture with port & catheter extending into the neck...now, without the port & catheter! 

Lessons Learned

Last Friday was the first Friday where I wasn’t either receiving chemotherapy or still nauseated from the previous week’s infusion.  While I couldn’t escape the cumulative fatigue accrued during the past 6 months, a slight sense of freedom percolated.  Without the IV (intravenous) lines holding me down for 4-5 hours, Chris and I were able to assist in moving our daughter and her 2 roommates into their new apartment.  With my weak and swollen right arm, my job was to sit (on her desk chair) and watch over the moving truck (and the belongings within), while the other parents and helpers removed all their goods, towing them to the 3^rd floor of the building across the street.  Instead of being tied down with IV tubing, I was held down due to my decreased arm strength and inability to lift, providing time to reflect on the lessons learned during these past 6 months.

As many of us don’t learn until we’re retired, living with another person 24/7 is challenging.  During this unique opportunity of being with the one we love nearly all day, every day, you learn all the idiosyncrasies between each other.  The differences in how one washes the dishes, the activities they perform while eating, or how they roll up the garden hose (or not) are all viewed with a more critical eye.  And yet, the biggest source of conflict generally encompasses how we utilize our time. 

Cancer provides a different vantage point of time.  Taking the extra time to place dirty dishes in the dishwasher or throw away mail after you’re done viewing it, may not seem like much, but can be a crucial act of love.  When two or more people coexist for the vast majority of each day, you see how each other utilizes their time.  While this insight may be enlightening (you may not realize how many tasks your spouse actually accomplishes during the day), it also can be a major source of frustration.  If one person is reading, sleeping, playing games or watching television, it can stir jealousy or frustration in the other as they are working to organize, clean or care for the home.  It reminds me of the bible passage about Martha and Mary when Jesus came to visit and Martha couldn’t understand why Mary wouldn’t help with preparing the meal (Luke 10:39-42).  If the other person isn’t doing what we value or think they should be doing, then we become critical, or even envious.  Yet, envy only breeds discontent.  To be happy, we must accept each other’s differences in priorities, approaches and abilities, while maintaining good communication so that both parties are satisfied. 

Freedom doesn’t buy happiness.  It’s the choices that one makes and approach to life that provides happiness.  Happiness won’t come from a game, a gift, or social outing, it truly comes from within.  The more grateful we are, the more we recognize and appreciate the blessings surrounding us and the happier we feel.  As annoying as my fatigue, hot flashes and arm pain have become, it’s much easier to ignore it, when sharing laughter, smiles and cordial conversations with friends and family.   The ability to learn, challenge myself and freedom of movement (i.e. walking/running) are much more rewarding to me than sitting in front of a computer or television, watching the world through someone else’s eyes.   So, although I’ve spent the past 6 months off of work and had the freedom to read, watch TV, etc., I never felt happy doing that.  I’ve always felt happiest doing what I love most, which is listening to people’s histories, discerning and assessing the issues, and developing a strategy to help them.  When my low white counts inhibited me from practicing medicine, I turned to writing, both as an outlet for me and with some small hope that I still may help others while not actually seeing them face to face.   Rather than being frustrated when I awaken at 2, 3, or 4 in the morning, I would just roll out of bed and tap on the computer, instead of lying there, hoping to fall back asleep.  Vacuuming or mowing the lawn probably would’ve been frowned upon at that hour (although it is amazing how bright it gets by 4 in the morning).

Lastly, as my father used to say, “Don’t judge a book by its cover.”  During the past several months, even as my hair started thinning, energy diminished and skin darkened (a side effect), I would hear, “You look good.”  While a part of me appreciated the compliment, another part of me realized how easy it is for people to “get it together” externally, no matter how they are feeling internally (be it physical or emotional).  That’s why I’ve encouraged, in previous blogs, mindfulness of others.   If people appear rude or disrespectful, treat them with kindness, as we never quite know what struggles lie internally.  Showing all people respect, courtesy, and forgiveness, will not only improve our own sense of worth, but may pass this joy on to another.  This is how the “pay it forward” campaign works.  Even if you’re financially strapped, you can pay it forward by letting someone go ahead of you in line or leave a close parking space for an elderly person or mom with little kids.  This small gesture, may alleviate someone’s joint pains and replace it with a smile of relief or gratitude.

Although my muscles may be weaker, I feel my heart is stronger and brain is wiser, from this journey.   I’ve learned a lot about myself while experiencing the roller coasters of menopause and maladies of cancer.   Even though the chemotherapy (at least this round) has ended, the brutality of it, remains.  And yet, I am a survivor.  Although there may be foods that I continue to avoid, swelling or pain that never resolves, or strength that I never regain, through this experience, I have gained so much more.  Cancer can’t take away the spiritual and emotional growth nor the true happiness provided by the love and support of caring friends and family.  Cancer isn’t a death sentence nor should it be feared, it provides the opportunity for us to pause and recognize our tenacity and the abundant blessings and beauty around us.  Sometimes our greatest strengths shine in our weakest moments.              

Forget what hurt you, but never forget what it taught you.   ~ Anonymous

The only mistake in life is the lesson not learned.  ~ Albert Einstein

A beautiful & captivating pastel drawing of a bald eagle, from a talented friend of my youngest son.  

Heart and Soul

Today was my first post-chemo diagnostic test.  One of the agents used in my biweekly chemotherapy regimen, Adriamycin (Doxorubicin), holds an 11% cardiac adverse event rate.  As mentioned in one of my previous blogs, this most commonly causes heart arrhythmias (heart rate issues) or cardiomyopathy (enlargement of the heart).   This being said, the side effects are dose dependent.  The more medication received, the higher the risk of cardiac issues.  However, most people will not incur chronic problems unless having repeated courses of chemotherapy with this medication (only 1.7% incidence rate).  Yet, two factors put me at a slightly higher risk of developing heart issues, my lower ejection fraction before initiating therapy and my hypertension (high blood pressure). 

If you recall, way back to January, my first echocardiogram (ultrasound of my heart) showed a slightly lower ejection fraction (EF), which indicates how much blood your heart pumps to the rest of your body.  It was presumed this was due to an “athlete’s heart” (a phenomena where heavy training/exercise actually reduces EF).  My initial EF was about 50% (normal is 55-70%).  As a consequence of this diminished EF, my echocardiogram was repeated after 2 months of chemotherapy to assure that this EF didn’t decrease any further (a sign of Adriamycin toxicity).  Fortunately, my second echocardiogram came in nearly exactly the same as my initial echo. 

Well, today I received my 3^rd and final echocardiogram, at the conclusion of this treatment regimen.  As I’ve continued to run and walk intermittently, and remained relatively symptom-free and normotensive (normal blood pressure), I remained hopeful.  My pace while running is currently 2-3 minutes slower than my norm and my mileage decreased by more than half (particularly as I have been walking more than running).  Yet, I have not experienced chest pain or shortness of breath with running or climbing stairs. So, I was eager to receive these results. 

It was nearly 5:00, when I received the call from my cardiologist.  “Well,” he said, “I think we can put to rest any issues with your heart from the initial echo.  Your ejection fraction actually improved and is now normal.”  Other than being ecstatic, several theories ran through my mind.   Were the enlarged nodes in the middle of my chest and surrounding my pulmonary artery to blame for my initial poor EF and now they’re gone?  Or did my “athletic heart” get deconditioned from my decrease in running and hard training, helping it to return to normal?  Is hard training and running 50 miles/week actually bad for your heart?  Reviewing the measurements (I always leave with a CD of my own), revealed a 5% increase in EF, actually putting me back into the normal range (barely, but I’ll take it!)  While I’ll likely never know the answer to my questions, I think these results delivered another message. More likely than not, the decrease in my training and intensity resulted in my improved heart function.  While I’ve been meaning to back off for years, once again, I needed a slap in the face to give me permission.  Running, while valuable due to the meditation and reflection time that it provides, can also become an obsession (ok, I know some of you are laughing).  Like vitamins, alcohol, and work, too much of anything can be harmful.  Finding a balance is key.   This will be my greatest challenge in the upcoming months.  But today, I rejoice in knowing that my heart remains strong. 

No beauty shines brighter than that of a good heart.  

The best and most beautiful things in the world cannot be seen or even touched - they must be felt with the heart.  ~ Helen Keller

These 2 photos were taken during recent "runs" (note the water droplets on the rose and antlers on the deer).  I see a lot of beauty (with my heart) on my runs.