Happy Easter

I’ve always loved Easter because it culminates a season that centers around Christ’s suffering and a season of fasting and sacrifice.  Easter represents the rising from the darkness and focuses on the light of Christ’s passion and what better season for this to occur than during the spring.  As the blossoms open and the bulbs start to bloom, the days become lighter and our spirit seems to uplift.  It’s a reminder that even through our darkest, most difficult times in our life, God is by our side and in the end, He will lift us up and we’ll become better and more beautiful through the suffering. 

As Jesus, stood, nailed to a cross, he was mocked and humiliated and treated like a criminal.  Not only that, his mother and friends had to watch this all occur, without any ability to change the course.  We can only imagine the physical agony of a slow death from piercings through your hands, feet and side but add that to the emotional suffering and feelings of abandonment at his most difficult moment and one realizes that whatever petty complaint or burden that I bear, pales by comparison.  Yet, 3 days later, he rose and returned to share the good news of forgiveness and God’s great plan.  It is through his great sacrifice, that I know that I will share in God’s glory some day and my spirit will join those that have gone before me.   It is because of this and because I do believe that God has a plan for all of us, that I do not fear death or dying.  That is the beauty of Easter Day.  It is all about the rising and the glory of God.  Easter is a time to rejoice, be thankful and reassured that all is forgiven and that life extends beyond the soil of this earth. 

I hope that each of us can spend this blessed day with those we love.  Whether it be through a phone call, a greeting or a meal together, may you feel God’s gentle touch and enjoy the light and freshness of this Easter Day and fresh start of spring.  Thanks again for all the prayer offerings and words of encouragement and wisdom that you have provided me during my journey. 

May all your prayers be answered and may you feel the Lord’s presence near you…not only at Easter, but always.  God Bless. 

This is our traditional family Easter day picture from 2011, with our Easter baskets and Sunday attire.  

Infusion #6 - HALFWAY POINT

As I sip on my orange flavored, glutamine-powdered, water, I couldn't help but think about the Bon Jovi song, "Living on a Prayer", since I'm at the halfway point of my lymphoma treatment regimen.  I've never paid much attention to the lyrics previously, but found them to be somewhat appropriate.  I've included a YouTube link, for those who may want to view/listen to the song:   https://www.youtube.com/watch?v=lDK9QqIzhwk (you will need to copy and paste).  The relevant lyrics that I appreciate include:

We've got to hold on to what we've got
It doesn't make a difference if we make it or not
We've got each other and that's a lot for love
We'll give it a shot
Woah, we're half way there
Woah, livin' on a prayer
Take my hand, we'll make it I swear
Woah, livin' on a prayer
Livin' on a prayer

Oh, we've got to hold on, ready or not
You live for the fight when it's all that you've got
Woah, we're half way there
Woah, livin' on a prayer
Take my hand, we'll make it I swear
Woah, livin' on a prayer

My apologies for not posting a blog entry for over a week. Thank God, it was a fairly boring and uneventful week as far as medical issues but filled with a multitude of appointments for an echocardiogram, cardiology consult and of course, my infusion.  In addition, my college kids returned home for spring break and have been keeping me occupied with sharing their grades, coursework/tests, work schedules, and then eventually getting a couple days off to Victoria, B.C. to enjoy the Butchart gardens, a fun run along the southern shores of Victoria and Beacon Hill park as well as experiencing the night life (I beat them both in darts--not that I'm competitive) and flavorful food.  The Clipper (a catamaran) ride north was fairly smooth with exception to a 15 minute delay due to debris catching in the propeller.  On the contrary, we had an extremely rocky boat ride back to Seattle in which many passengers "lost their dinner".  Fortunately, I took my strong nausea medications for both trips, which helped immensely, but even with that, I still incurred some nausea.  Kim and Scott faired very well and the boat attendants were very responsive and passed around ginger candies and "bags" for those needing them (Kim and Scott both consumed the ginger candies).  A couple sitting nearby even shared dramamine.  Fortunately, the teens adjacent to us, took them up on the offer, as they were looking quite green.

Today's infusion started like most others, with the usual weigh-in (for calculating the appropriate dosing of the medications) and then getting escorted to our bay.  After arriving in bay 12, which appeared much roomier than other bays we've experienced, the remaining vitals were taken (BP was 130/80, temp - 98.0, pulse - 58, all pretty typical).   My infusion nurse, Kim, arrived and after conscientiously cleaning off my port and accessing it, she drew my lab work and heparin-locked the tubing to prevent any clots while we waited for the results.  Twenty minutes later, she reported that my ANC (absolute neutrophil count) was quite low at 0.4 (normal is 2.0 - 7.3), so she would have to call my oncologist before getting the go-ahead on ordering my chemotherapy medications.

Given the low counts significantly increase my risk for infection, many oncologists will adhere to an ANC cutoff of 1.0 for persons over age 65 and 0.5 for those under 65, to proceed with chemotherapy treatment.  So, you can imagine my mind started wondering about the next steps.  If I delayed until Monday, that would change our entire schedule.  Chris bowls on Monday mornings, so I would either have to transport myself (and lose out on the carpool lane, the most important factor) or we'd have to proceed to afternoon appointments. And, if we choose to continue on my current schedule, I'll need to be extra cautious with avoiding sick contacts and continuing with meticulous hand-washing and disinfecting.  Admittedly, I've become a little cocky, since I've come out unscathed (from an infectious standpoint) so far.  But, my ANC has never been this low.

While all these thoughts swirled in my mind, my doctor worked her way around the bays, and eventually arrived in bay 12.  We had a long discussion of the pros and cons of continuing on schedule but deep down, both of us wished to proceed.  You see, one more thought rumbling in my head was that if my ANC and other blood counts were so low, then maybe it's killing more of those bad-boy lymphoma cells as well.  So, we agreed to move forward and stay on schedule, knowing the potential infectious risk and prepared with potent antibiotics if fever arises.

As my college kids return back to school Sunday night, my daughter was kind enough to visit me

Kim paid a visit after getting off of work. 

during my infusion today (see picture).  Their return should lower my risk of infection (as both Kim and Scott work directly with the public and handle money throughout their shifts), however, they both are fairly fastidious with their hand-washing and exposures as well.  I don't have many plans or appointments for the upcoming week, so I should be in good shape to boost my counts.  Lastly, the upcoming sunny weather predicted will help me get outside, decreasing further germ exposure.  A part of me sees this as a new challenge to see how strong my body really is and how low I can go with my ANC without getting into trouble.  And oh, how I love a challenge!

There is so much more for me to write, but I'll reserve for a future blog post.  For now, I am still so tremendously thankful for all the love, support, thoughts and kind words through cards, meals, gifts, Facebook, posts on this blog, walks and even those that are quietly praying, I truly appreciate it all.  Every day, my desire to return to work increases, particularly when I cross paths with colleagues, employees and customers (patients).  You all inspire me!  Not only do I appreciate the kind words, but also the support and understanding of my medical leave and desire to return as soon as I am able.  Through this experience, I have learned so much about the patient experience which I hope will improve my perspective and overall care for every person I encounter.  In some ways, this is like one long, continuing medical education (CME) experience.  (If only the AAFP would recognize this for CME credits.)  While awaiting this to occur, I'll continue my journal reading and online CME courses, but want to give a great big hug and thanks to all of you and to our great GOD above for keeping me healthy and strong throughout this journey.  13.1 miles down, 13.1 miles to go!

Strength does not come from winning.  Your struggles develop your strengths.  When you go through hardships and decide not to surrender, that is strength. ~ krexy.com

You have to be at your strongest, when you are feeling at your weakest. 

The kids finally reunited with me (after ditching me in the first 5 minutes at the Butchart Gardens), in the last 10 minutes of our tour.

The top picture is taken at Beacon Hill Park in Victoria, BC and at mile 0 of the Trans-Canada Highway, which spans all 10 Canadian provinces from the Pacific to the Atlantic Ocean.  This statue depicts Terry Fox (July 28, 1958 – June 28, 1981) who died from bone cancer just shy of his 23rd birthday.  His right leg was amputated due to the disease and during his treatment, he was so moved by all the young kids stricken with cancer that he decided to raise funds to further cancer research by embarking on a run across Canada (hoping to get $1 donated by all of Canada's 24 million people).  His run, which started in 1980, lasted 143 days and spanned 3,339 miles but was cut short by metastasis to his lungs, requiring hospitalization.  He was well known when I was a teen and his amazing journey made headlines regularly.  He was and is an inspiration for all who are fighting cancer and choose to stay active and he is considered a national hero of Canada.  On this memorial, there are several quotes from him, which include:  "Somewhere the hurting must stop..." and "Dreams are made possible if you try."  There is a movie about his life if you feel compelled to learn more.  

An Irish Blessing

Top o' the morning to ya and a Happy Saint Patrick's Day.  I'm not sure why, but ever since I was a little kid, I wanted to be Irish.  The Irish always seemed to be having a good time, whilst sharing eloquent limericks and clever sayings.  As an adult, I learned that much of this was likely the result of the amount of alcohol they drank.  While touring in Ireland this past summer, we learned from a tour guide, that the water was either so terrible (from the diversion of the water supply through the paper mills) or less readily accessible than beer, that the children of Ireland (usually in the poorer suburbs of the city) were provided beer rather than water as their mode of hydration.  Now, I have never been able to validate this claim, nor do I recall what years this occurred, but it would explain their affinity toward alcohol and potentially why they always seemed to be singing and dancing.

What does all of this have to do with me?  Absolutely nothing.  In fact, I'm only posting today because I haven't written for quite some time and I don't want y'all wondering what happened.  This is my "post-infusion" week, wrought with nausea and fatigue and nothing worth bothering to report.  Even though I've had a total of 5 infusions, I'm still surprised at how much harder it kicks me to the ground each time.  Symptoms linger a little longer, subtle new symptoms arise (this week it's fingernail discoloration and leg cramps) and I sleep A LOT!  "Next week will be better," I tell myself.  Yet, I still yearn for that ability to crank through an 18 hour day at full steam.  It will come.  I know.

My day is filled with little victories.  Getting the tax paperwork together may have taken 4 days but it's now ready to send.  Calling for window washer estimates (so I might be able to enjoy looking out them) may be the one feat I accomplish.  Nonetheless, I still get to enjoy the greeting from my 16-year old son when he comes home from track or help him with his pre-calculus homework.  My two older kids will be home next week for Spring break and I should be feeling more spry to partake in their humorous banter.  Nearing the half way point of this journey, I still feel so blessed to have the love and support of so many and my husband by my side through it all.  While I still have about 14 miles to go in this marathon, with its hills and turns, the cheering and support along the way lighten the load and keep me propelling toward the finish line.

May God give you...
For every storm, a rainbow,
For every tear, a smile,
For every care, a promise,
And a blessing in each smile. 
For every problem life sends, 
A faithful friend to share, 
For every sigh, a sweet song,
And an answer for each prayer. 

The Eagle - Infusion #5

My brother instructing my 80 y.o. dad how to jet ski. 

It was after 6 pm on a Monday, when I finished with my last patient and finally got a chance to glance at my cell phone.  There were 3 messages from my mother, each of them more distressing.  She and my father were finishing their 4 week vacation in California, with my aunt and uncle.  She described the horrible headache and associated weakness that my father was experiencing and sought my medical advice. My heart sank, these messages were left during the past 2 hours.  This was the event I had feared ever since that summer day, 2 years prior, when I sutured my father's simple chin laceration, after a minor trip on pavement.  My dad was on a very potent blood thinner, that left him bleeding (via a slow ooze) for hours, despite my excellent suture skills.  Three hours after stitching his chin and 30 minutes in the supine position (laying flat), the bleeding finally ceased.  So, my big concern, when hearing these messages, was that this headache was the start of a fatal head bleed. By the time, I called my mother, they had called the medics and he was off to the hospital.  

One of my favorites:  My dad and nephew

Unfortunately, my prediction came true. Not only did my father suffer a massive head bleed (stroke), he actually suffered a cardiac arrest on the way to the hospital and they promptly resuscitated him. That night, my siblings and I conversed, rallied and agreed to meet in California to be with our parents, the ones who loved and supported us throughout our lives.  Despite our busy schedules, we arranged flights and left our worldly obligations behind, and were by our parents' side within 24 hours.  Given there are 7 of us kids, this was quite a feat.  After days of prayers, with a priest (my brother) by his side, my father made miraculous improvements that shocked even the neurologist who had never seen anything like this in his 20 years of practice (he even used the word, "miracle").  In my mind, God was acting on behalf of all of us, to unify our family further, remind us about the importance of spending time with our loved ones, while they are still here and several other reasons for which I'll save for another time. Two and a half weeks later, after saying his goodbyes with hand gestures and opening his eyes, my dad left this world and moved on to be with his Father in heaven.

It's been nearly 6 years, since my father was called to heaven. On the day of his funeral, I ran with more passion and fervor than ever before. Tears streamed down my face as I raced along the paved trail, remembering all the fabulous times we shared and worrying that I never expressed enough, my deep love and appreciation for all that my dad provided and taught me along the way.  Looking around the grassy knolls and trees lining the trail, I looked up and noticed a beautiful, majestic eagle looking down at me. As I advanced, the eagle continued to follow me along my route. He gracefully soared through the sky, matching my every mile, providing support and solace and alleviating my sadness and grief. From that day forward, the eagle appeared on my runs nearly daily. It was as though God had given me a companion, reassuring me that my dad was at peace and that he would remain by my side, particularly when I needed him most. 

For years now, whenever I struggle, worry or even feel sorrow from missing my supportive, loving and generous father, the eagle will appear on my run.  Sometimes, more than one eagle will soar overhead.  Most of the time, this occurred shortly after attending a funeral of another friend or relative.  It was as if God and my dad, were consoling me by revealing that these people, whom I cared for so much, were with Him, in heavenly peace.  So, when the eagle showed up this morning as I ran through familiar neighborhoods, it touched me and my fears turned to tranquility, knowing that my God and my father were watching over me.  Knowing that next week my body, weakened from today's chemotherapy infusion, will struggle for energy--energy to stay awake, think, walk and particularly, run, I needed this reassurance.  

As the fatigue increases, it's easy to dwell on the negatives and yearn for life as it was before cancer. Even the strongest, can't help but feel depressed at times.  This, coupled by the ill side effects of the medications, often lingers for nearly a week after the infusion.  My coping mechanism is choosing to think of the positives first. The well-wishes, cards, thoughts, prayers and meals from my patients, my neighborhood, my friends and family has been immense. It reminds me of God's plan for me and provides the love that I miss, by being unable to work while my counts remain low.  The remarkable medical progress, fabulous researchers and care providers that have improved the prognosis for all persons diagnosed with lymphoma makes me feel incredibly blessed.  Even though I won't likely run another marathon, the fact that I can still run, even if it means stopping 3 times per mile, makes me happy.  There are so many reasons to be thankful.  Compared to the tribulations of many others, including those who suffer chronic pain, difficult to treat mental conditions, or who have had their homes and dignity stripped from them, this trivial trial in my blessed life, is nothing.

While peering up at this mighty and majestic creature, the symbol of our country's freedom, I can't help but feel hope. That elegant, strong, placid eagle stood upon a barren branch, completely void of needles, high atop an eighty foot tall evergreen tree which showed abundant, green needles in its lower branches. "How symbolic," I thought, "while a part of me will die today, with every toxin they inject in my veins, there is still life that lies below." My husband, the forester, informed me that the tree will not only survive below the barren branches, but possibly branch off into new directions, stronger and more interesting than before, continuing to follow the light of the sun. Hopefully, so that little ones may climb those even stronger, lower branches and share smiles, laughter and feel secure in its arms. 

When a storm is coming, all other birds seek shelter.  The eagle alone avoids the storm by flying above it.  So, in the storms of life...May your heart sore like an eagle. 

"But those who hope in the Lord will renew their strength.  They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint."  Isaiah 40:31

My two oldest kids shared many smiles climbing the strong branches of a tree in my parents' yard. 

             

A Glowing Report

Walking back to the injection room in the back of the imaging center, my stomach growled.  Fortunately, the same nuclear medicine technician that performed my PET scan 2 months ago, briskly hustled several feet ahead of me, that he couldn’t hear it.  He prepped my arm for an IV and drew up the tube of blood to check my sugar level as I lay on the gurney with the heated blanket that warmed me after arriving through the chilly wind and driving rain.  After receiving my blood sugar result of 93 (normal fasting is 70-100), he injected the nuclear tracer into my arm and then promptly removed the IV.  Now, the waiting begins.  As I lay on the gurney playing games on my cell phone, my arms eventually tired of holding the phone in the air and my body succumbed to the warmth and I fell into a light sleep.  Naturally, after a day of a no-carbohydrate diet and 15 hours of no food at all, my dreams evolved around food and images of pizza, chocolate molten cake and raspberries swirled through my head.  Roughly 30 minutes later, the bliss ended as I walked back to the scanner machine. 

This time, they directed me to raise my arms overhead as if reaching for the sky in a yoga pose.  As the scanner moved me back and forth, my hands started to tingle.  This was not a position that I could stay in for long.  I was trying so hard to keep still, but my right shoulder actually started to shake.  “Was I really that weak in my arms and upper body,” I thought.  The next thoughts focused on trying to remain still for the imaging and trying to distract myself from this uncomfortable position.  “It will be over soon,” I kept repeating in my mind.  Then, I started thinking about what I would eat for lunch.  Again, food is the best distraction of all.  Eventually, the table started moving toward light and I heard the door open and knew that it was over.  Phew, I survived another one.  Putting my ring back on my finger, I gathered my glasses, watch and purse and returned to the waiting room, where fresh coffee awaited me.  Imaging centers and offices that provide coffee to their patients have a very special place in my heart, especially when they require you to fast in the morning.  Finally, I could devour the crushed granola bar that lay at the bottom of my purse (a remnant from our trip to California) as I sipped on my luscious java.

Since I was heading to review the images with my oncologist, I asked for a CD with my scan pictures.  Nearly 15 minutes later, the tech delivered the CD and off I drove, across the freeway, to the hospital.  I quickly found my way to the imaging reading room and asked the kind receptionist if I could meet with the radiologist who would be reading my scan.  After a brief wait, the radiologist escorted me back to the darkened cubicle where my images were displayed on a computer.  There were clear differences between the old and new scans.  Many of the enlarged lymph nodes were back to a normal size.  My spleen and abdominal lymph nodes no longer displayed the tracer.  My results, much like me, were glowing.  I immediately walked over to deliver the news to my oncologist and as we sat in the lobby with smiles on our faces, I couldn’t help but feel thankful and blessed once again for all the support, prayers and positive thoughts from friends, family, patients, coworkers and care providers.  God is good!

If God answers your prayer, He is increasing your FAITH.  If He delays, He is increasing your PATIENCE.   If He doesn’t answer, he has something better for you.  ~ Author unknown

The Adventures of RATWoman

It’s amazing how much you crave or miss something when you know you can’t have it.  Tomorrow is my interim PET scan to determine the efficacy of my chemotherapy treatments on the lymphoma (cancer cells).  In preparation, I must remain on a carbohydrate/sugar deficient diet.  In layman’s terms, you can’t eat anything that tastes good.  This may be a slight exaggeration.  I can eat salads, green vegetables and protein products that aren’t marinated in sugar or mixed with anything carbohydrate.  So, pretty much I can have meat, fish, eggs, cheese, salad and broccoli but without any pasta, bread, milk, sweets, salad dressing (other than oil/vinegar), fruits, crackers/chips, beans, potatoes, rice or any vegetable other than green.  What’s even worse is that “no strenuous exercise” is permitted the day before the procedure.  I wonder what they consider “strenuous exercise”.  For a marathoner, certainly running 5 miles isn’t strenuous.  But, who am I kidding, running even 1 mile is strenuous for me at this time, so there is no fear of noncompliance on my part.

There is a lot riding on this PET scan, that I certainly wouldn’t take any chances at messing it up.    The fate of my treatment regimen relies on these results.  If the lymphoma tissue shows less metabolic activity (less tracer uptake) than my liver, then I am winning the battle and get the privilege of finishing 4 more months of the ABVD drugs that we’ve all come to know and love.  (We love them only because they are annihilating the evil cancer cells that lie below.)  If the results show the lymphoma is winning, then, we will gather the troops, strategize, and develop a new plan of attack, leaving no prisoners behind. 

Come tomorrow, I will henceforth be known as, RATwoman.  The RAT stands for RadioActive Tracer.  (Well, let’s see you try to come up with a better superhero name on the fly.   Harder than you think, isn’t it?)  Not only do I get to pretend that I’ll be transformed into a superhero with the radioactive contrast they inject, they greet me with a lovely grape-flavored, white, chalky liquid to drink for breakfast when I arrive. Regardless of the results, RATwoman will continue her pursuit of eliminating all crimes against normal cells and abolish the evil empire known as cancer.  We may need to develop new weapons or utilize our allies to generate more force, but in the end, good always surpasses evil, and the enemy will be defeated. (Chime in with a glorious John Williams score and we’ve got ourselves the making of a movie).  Stay tuned to determine the fate of the empire.  Results should be available by Tuesday.  May the force be with you.

The world will not be destroyed by those who do evil, but by those who watch them without doing anything.  ~ Albert Einstein. 

My Recliner

21 years ago, Chris and I ventured out to find the ideal piece of furniture to match the light blue sofa that was the living room centerpiece in our Greenlake (Seattle) home.  Since I was still in medical school and we had a child on our way, we needed something economical, durable and practical.  Being the frugal individuals that we are, we thought a navy recliner with rocking capabilities would be just the right fit.  As we entered the Lazy Boy showroom, with the numerous choices available, we immediately were drawn to one that fit our criteria.  Upon choosing our selection, the salesman promptly offered to Fabricoat it (which guaranteed protection from spills and stains) at an additional cost.  Normally, Chris and I would be skeptical of such glorious claims but knowing that we would soon have little critters crawling around, we elected to add the Fabricoat.  This was probably one of the best decisions we’ve ever made.

We promptly put our recliner to test when feeding baby Kimberly.  The recliner became the most convenient place to give Kim her bottle of milk, which she quickly downed.  After finishing her bottle, we would burp her and then read a book, trying to assure that she remained upright for at least 20-30 minutes after her meal.  As happily as she downed her milk, however, it rapidly came up and out, all over us and our lovely recliner.  Amazingly, the recliner cleaned up nicely and sure enough, never revealed the punishment it endured. 

Many a picture was taken on the recliner.  We generated pictures with Kim and Scott together as toddlers, pictures of relatives holding our children, pictures of us and our babies taking a rest after a long day and even the occasional selfie.  When returning from a long night of call, I would often rest with the footrest outstretched for a few moments of shuteye.  On other nights, when I returned home, the kids would grab a book and we’d sit together and read, while rocking in the recliner. 

The 3 kids in the recliner, holding a rug hooked by their Great Grandmother, Iola Platz.

As the years progressed and the kids got older, the recliner became “mom’s recliner”, as it was typically where I’d land after a long day of work.  If we watched a movie or played a Wii or Xbox game, mom would be sitting in the recliner while everyone else found a place on the floor or sofa.  Many teenage conversations occurred and many papers/homework were reviewed and revised while sitting in my recliner.  After the kids drifted off to bed, the recliner became the place where I’d finish off my work for the day – a nice, comfortable, cozy location for reading or working on the laptop.  My recliner has endured rough housing, spills, and battles, while generating many memories. 

Now, my recliner is my respite.  It is where I sit, rock or lay when I don’t have the energy to do anything else.  When I’m nauseated, I turn to my recliner for comfort.  And it still never fails me.  As I type, I am in my recliner.  Some of my greatest thoughts and conversations have occurred in this ever-sturdy chair.  And despite all that it’s been through, it remains as beautiful to me as ever.  You would never guess that it is 21 years old and while our first sofa has since been replaced, this rocker remains.   I’m sure there will come a day when the recliner will be retired, but until then, I hold on to all that it represents.  Much like the fabric of our lives, it has stayed true to its color, endured the test of time, and created fabulous memories along the way.  Although it is just a piece of furniture, it remains a cozy, safe and sturdy place for me to find comfort and rest. 

Cheering on the Seahawks in my recliner during the playoffs. 

"Almost everything will work again if you unplug it for a few minutes...including you." ~ Anne Lamott