It’s Snot Funny

This blog entry is another one that I wrote shortly after my first treatment for lymphoma, but was awaiting the right time and place to insert it.  Since many of you are suffering from the flu or allergies, and the fact that I won't get to enter a blog post on 2/29 for another 4 years, I elected to submit this entry today.  It may not be a palatable topic, but I hope you find it interesting and humorous (as I intended).

OK, maybe not one of my more clever titles or even one of the most appealing topics to cover.  But, admit it, you’ve always wondered why and how one person can produce so much snot.  If you’d prefer the word phlegm, boogers, mucus, well, I’m sorry.  I prefer the term snot!  It just sounds so definitive and slimy (and it is).   WARNING:  If you get a queasy stomach or you are currently eating, you may want to skip this blog entry or return to it at a later time. 

If you’ve read my earlier entries, you might remember that one of my earliest symptoms of lymphoma was an abundant cough and phlegm production.  We’re accustomed to loads of snot when we have a cold, so this didn’t surprise me, except when it only worsened and never went away.  Well, I’m happy to report that the mucus production and cough are vastly improved, even with the first treatment.  But, surprisingly, the nasal snot production is still often present.  The used Kleenex piles have created avalanche risks near my bedside table, family room table (next to my trusty recliner) and every car, bag, and purse I use, has a Kleenex supply handy.  We all know that snot/mucus serve to protect us from environmental invaders such as dust, viruses, pollen, etc. but why continuously produce it while you are fighting cancer?

After extensive research (I googled it on the internet), I’ve found that the average person produces about 1 liter of mucus every day.   That means, our bodies are constantly being assaulted by smoke and irritants from our environment that the mucus is trying to eliminate.  Well, initially in my illness as the lymph node masses in my chest were enlarging, they were compressing on the bronchioles which caused irritation.  Our natural defense mechanism to irritation is…mucus production.  So, I would cough up a lot of mucus.   (I now wished I had actually spit it into a bottle and measured the quantity so I could produce my own internet research!)  Nonetheless, when the cilia (little hairs in our airways that help clear mucus), get overwhelmed, it allows our nose to run rather than producing dried boogers and forces us to cough in order to clear our passageways.  Cold weather, decreases the cilia cells ability to function, which is why our nose becomes drippy when we are outside in the cold.

Although I implied that my snot production has increased with my cancer, I honestly think that the lymphoma primarily changed my habits.  Rather than swallow the mucus/snot throughout the day which is what most people do, I got in the habit of coughing it up or blowing it out because my swallowing mechanism was impaired.  My esophagus was also compressed by the lymph nodes such that rather than swallow, I would spit up the phlegm, cough or blow it out.  Now, any irritation in my nose, makes me want to blow it, rather than letting it go down its usual digestive course.

Yes, I know this wasn’t the most appealing topic, but in between naps, I have the time to ponder about such wonders of our body.  When you really get a chance to wonder, you realize the infinite complexities of the human body and the amazing adaptations that we have produced to survive.  Snot is just one of these wonders but no less important.  So, think about that, the next time you blow your nose or cough up some phlegm.  Your snot is there to save you!

Mystery creates wonder and wonder is the basis of man’s desire to understand.  ~ Neil Armstrong

The Value of Sleep

Late to bed, early to rise, makes a woman silly and fried.  It's amazing the restorative powers that even just a little sleep can provide.   Awakening to the birds chirping, after just 4 hours of laying down, I find myself unable to fall back into a stupor.  Instead, I battle for 30 minutes,  eventually surrendering to the inevitable.  It's time to generate that first cup of fuel and plan the day ahead.

If you've never had the privilege of experiencing the steroid energy boost, well don't feel disappointed.   When it hits you, like an approaching train refusing to slow down, you have no choice but to jump on and see where it takes you. Occasionally, the train will take you to somewhere creative and brilliant  (I always hope for this one ).  Leading you to a place producing new ideas and approaches to sometimes simple but possibly even complex tasks.  Today, for instance, I was reminded of a different app on my phone that I could utilize to record my blog thoughts that would ease the transfer from my phone to the blog site.  Not only that, I immediately dove into brain dump mode.  Believe it or not, I perform my best, first thing in the morning,  with or without that first cup of coffee.

Occasionally, the thoughts arise completely random. For instance, I created an entire list of names for dogs--of which we will never use, since Chris is allergic to dogs.  I'm pretty sure that looking at my nephew's Facebook post about adopting some very adorable puppies just before bed, sprouted these thoughts.  

Although I wrote this post yesterday morning, I chose not to publish it then since I had just published a blog post just hours before (this was done about 6 in the morning).  Instead, I complete this after finishing my cup of java on a relaxing, rainy, Sunday morning after about 7 glorious hours of sleep.  Fortunately, the jitteriness of the steroids has dissipated as well as the frenetic ideas.  Along with that, the energy level has diminished, but I'll take it, to return to normal more quickly.  No matter, I've still got my positive attitude and will continue to power through my unlimited to-do list, with naps interspersed.  Each day is a blessing and I choose to make the most of this one. 

From a Winter walk in Kenmore.

May you always have enough happiness to keep you sweet; Enough trials to keep you strong; Enough success to keep you eager; Enough faith to give you courage; And enough determination to make each day a good day. 

Infusion #4: Finally Feeling It

For the first time, I find myself nauseated, days before my infusion.  Every time I talk to someone about chemotherapy, the wave of nausea flows through my body, producing putrid smells, a jumpy stomach and a dizzy, warm feeling extending from head to toe.  I know those of you who’ve been through a cancer journey of your own, understand this feeling.  For me, it dissipates as I get busier or if I go for a walk or run.  Unfortunately, the fatigue has thwarted my running efforts once again, but I still feel blessed to have the longer days and sunshine to lift my soul.  The vacation away from the Seattle rain was a vital distraction.  

Upon awakening for today’s infusion, I experienced that familiar nauseated feeling once again.   I dragged myself out of bed in hopes to complete a 3 mile run, but cut it short at 2 miles at a fairly slow pace, with 1 walking stop in the middle. It helped my appetite enough to eat a half of a peanut butter and jelly sandwich.  Chris and I headed to the infusion center and the usual smells started stirring unpleasant sensations again.  Thankfully, the labs returned quickly and were stable enough to proceed and with that first infusion of anti-nausea medication, I felt profound relief.  Yes, I increased my Decadron (steroid) dose back to 10 mg to reduce the nausea further.   Dry, crisp Utz pretzels from Pennsylvania (from our dear friends in Maryland), eased the stomach pain without provoking further nausea.   The Decadron is predictably providing the energy (i.e. insomnia) for me to blog again and hopefully will result in completing some of the organization and housekeeping projects I’ve started.  My list is still 4 pages long. 

Receiving my Adriamycin

My numbers (aka blood test results) are stable.  In fact, my absolute neutrophil count was slightly higher (at 1000 instead of 600).  It is still less than half of normal, so I’ll still avoid ill contacts and take appropriate precautions (in case any of my providers are reading this!)  My liver and kidney function remain normal and my sedimentation rate (an inflammatory measure) went from 4 times the upper limit of normal back into the normal range.  While I remain cautiously optimistic, the true revelation will be my PET scan on Monday, March 7^th.  Regardless of the results, there are always other effective treatment options.   Thanks again for all of you who are cheering me on through prayers and well wishes.  Don’t stop now, we’re still only a third of the way done with this marathon.  

Energy and persistence conquers all things.  ~ Ben Franklin

The road can be brutal.  It often kicks your butt.  Sometimes it scares you and beats you up.  But there comes a day when you realize that you’re not just a runner, you’re a survivor!  You’re tougher than anything it throws your way.  You are…a road warrior.  ~ author unknown

The journey can be exhausting for the support provider too. 

A Necessary Vacation

Many people think that it is poor timing to go on vacation when you have cancer and actively receiving chemotherapy treatment.  Yet, sometimes, this is exactly what is needed to get out of the doldrums and monotony of “counting the days”.  It’s so easy to categorize each day by your treatment or side effects:  mouth sore Mondays, infusion Fridays, sleepless Saturdays, and the list goes on.  Each day in my two week treatment plan is characterized by either a symptom or a treatment.  Infusion Fridays are like a mile marker in a marathon, I look forward to passing them on my way to the finish line.  Fortunately, everything has been fairly predictable and proceeding like clockwork.  But, that finish line still seems miles away, which is why a getaway and change in scenery is immensely beneficial.

This vacation (which we had planned and paid for back in September, i.e. prior to diagnosis), gave all of us (Chris, Peter and I) a break from the familiar.  It provided a chance to reunite with family and friends, share in some much warmer, sunnier weather and play outside in the fresh air. 

Air is the sustenance of life.  However, on an airplane, re-circulated air can pose an infection risk, which is why so many people are anxious about travelling with neutropenia (low white blood cell counts).  To minimize this risk, I wore a mask throughout the flight and closed all the nearby ceiling air vents (as advised by the chemotherapy RN) to avoid the re-circulated air from blowing directly on my face.  Since we flew Southwest (SW) airlines, we were lucky to be sitting next to familiar people (some patients of mine and a family from Peter’s high school) on the way down to California, which made this request easy to fulfill.  On the return flight, the couple next to me were cold and wanting to sleep, so they too, closed the vents without my asking.  One advantage to flying SW and choosing our seats last (aka cheap seats), we could purposely look around and avoid sitting near coughing people or young children (who tend to always be carrying some active infection).

After dropping our bags off at the hotel, we immediately proceeded to dinner with my aunt, uncle and cousins (one of whom I hadn’t seen since our wedding over 22 years ago).  Just like old times, we reminisced about all the summers we spent together, laughed a lot (particularly when on the phone with another cousin) and shared in a terrific meal.  Fortunately, we were able to get an early start on the evening, because, as expected, by 8 pm, the fatigue settled in and suddenly I find myself a silent observer rather than an active participant.  I was thankful that the drive to our hotel was only 45 minutes and that we had nothing planned the following day except to soak up some sun at the beach prior to enjoying dinner with friends in Huntington Beach. 

A relaxing, sunny day at Huntington Beach

Without boring you with arduous vacation details, I must include the essentials for taking a trip while neutropenic.  Prior to leaving, a trek to the store was needed to obtain disinfectant wipes, hand sanitizer, sunscreen and snacks to decrease nausea or stomach issues (for me, it was Good and Plenty licorice bites).  The disinfectant wipes and hand sanitizer remained in my purse for easy access.  When sitting at a public bench or table (even at restaurants), I always cleaned them first.  Masks were used in public, enclosed, indoor settings (which in my case, was only on the airplane).  As instructed, I had my thermometer handy (also in my purse) and continued to monitor temperatures twice daily.   Although it was February, sunscreen was still necessary given the 80 degree temperatures and closer proximity to the sun.  Unfortunately, my son didn’t apply generously enough and suffered the consequences.   Many medications can increase sun sensitivity which makes sunscreen application even more crucial. 

Returning to Washington without any infection or ill effects is testimony to continued precautions while vacationing.  The key to success is good hydration, frequent breaks, sleeping in, monitoring fatigue levels and varying the days between active and inactive.  Keeping away from public, enclosed areas, eating healthy snacks and homemade meals were also very helpful.  Staying active, which consisted mostly of walking, kept my appetite alive, resulting in greater energy levels.  With our non-refundable airline tickets and hotel reservations, I was determined to make this vacation happen, even if it was just Peter and Chris attending.  Thankfully, with God’s great intercession, we were all able to vacation together, making more joyous memories to help us forget the unpleasant ones.

The best things about MEMORIES…is making them. We travel not to escape life, but for life not to escape us. 

Lunch (on his birthday) with our Michigan (now a Californian) cousin. 

Another sunny day spent with our niece at Huntington Beach.

Treatment dilemmas...

Sorry to leave y'all hanging.  I went on a planned trip to visit relatives and friends, which left me without a computer nor the time and energy to post. Now, since I'm on a plane, fully masked, with my kindle, I can judiciously reflect on this week following the change in my infusion regimen.  

As you may recall, I chose to decrease the dose of steroid, in order to achieve improved sleep and concentration.  The first night after infusion was just as detrimental to my sleep as when I received 2.5 times the dose. As you may have guessed, this impaired my focus and concentration the following day.  The next 2 nights were not as severe, but still left me fatigued.  By the fourth day after infusion, my sleeping was vastly improved, which also helped my mental capacity to form not only relevant thoughts but I may have even contributed cognitively to conversations.  It was refreshing to feel like my mind was operating in its normal, witty fashion.

However, there were definitely trade-offs.  Steroids are administered to ward off nausea that occurs long after the infusion of the chemotherapeutic agents.  So, naturally, there are consequences to lowering this level.  The nausea was definitely more noticeable within 24 hours, but I still managed to avoid anti-nausea medications until nearly 36 hours after infusion.  I continued to need them for nearly a week, whereas previously, I rarely took them at all after the third day following infusion.

The other consequence that I noticed was an increase in neck pain and headaches, which hadn't occurred previously (steroids have great anti-inflammatory effects to decrease pain).  Given the platelet-lowering effects of the medications I receive (you may recall that platelets are blood cells that help form clots), anti-inflammatory drugs such as ibuprofen or Aleve should be avoided, since they can cause bleeding.  This leaves the options of acetaminophen (Tylenol) or some sort of narcotic (Vicodin or Oxycodone) for the headaches.  Typically, I choose acetaminophen first, as narcotics can cause a "loopy", drugged sensation and contribute to nausea as well.   Either way, this was an inconvenience that was easily managed.

Nonetheless, headaches recurred intermittently for 3 days.  Now, it may not have been directly from the reduction in steroids but possibly hormone related.  You may have heard the recent studies showing the increase in migraines peri-menopausally.  Given the hormone changes associated with chemotherapy, I definitely have noted some hormonal changes.  However, I'll spare the  details at this time.

In a nutshell, will I stay on the lowered dose, lower the steroid dose further or go back to the higher dose?  At this point, I'm leaning towards going back to the normal regimen.  However, another part of me desires a trial off steroids completely, as I really enjoy the clear mind, focused concentration,  and improved sleep, then I would just take nausea medications as I need.  My fear is that the nausea and pain could significantly worsen, leaving me just as drugged in other ways.  This is why my tendency would be to return to the original regimen, because I know this regimen has already been studied and tested to ensure the best possible results for the patient, which is how it was likely designed.    If given the choice of obtaining sleep/clear thinking but increased nausea and headaches versus insomnia/disorganized thoughts but no pain and nausea, which would you choose?  

I am who I am today, because of the choices I made yesterday. ~ Eleanor Roosevelt

Infusion #3: Modifications Made

Yesterday marked my day 1 of cycle 2 (aka my 3rd out of 12 chemotherapy infusions).  Chris and I arrived at 10 am, to a completely empty waiting room at the cancer care center, a sharp contrast to last week's overflowing crowd and standing room only.  I was summoned immediately for my blood draw to once again evaluate my blood counts and metabolic panel (kidney and liver functions as well as blood sugar and electrolytes).  Since accessing my port is necessary for my infusion, the phlebotomist volunteered to set up IV access at the time of the blood draw.  This is the first change from my previous appointments and actually quite convenient because I avoided a poke in the arm and I already had placed EMLA cream (a numbing agent) on my port to decrease the pain. However, this is a much more laborious process than just sticking a needle into the skin.

Accessing a port that is buried under the skin requires extra training and caution to avoid infection risk, so they clean repeatedly with swabs containing a comprehensive anti-bacterial agent (but unfortunately, smells horrific, worse than rubbing alcohol).  They then place the needle with IV tubing directly between the prominent 3 dots of the port (see picture below).  Being on the thinner side of average, my port and these dots are easily visible, which nursing and lab staff seem to appreciate.  After the tubing is setup, it must be securely covered to not only stay firmly in place but also to avoid potential bacterial exposure near the site of entry to such a major blood source.  Unsuccessfully, I tried to coerce the phlebotomist to give me a different adhesive covering than I received at the last visit, since I had a striking rash/hives in the area of the adhesive that lasted nearly a week despite steroids (I have an adhesive allergy).  As she was unsure of what dressing was used, she used the usual TegadermÔ, which rapidly developed into a fiercely itchy and red rash (see picture).  Regrettably, by the time I arrived at the infusion center (around 11:40), the covering required removal by the RN and replacement with a hypoallergenic bandage instead.

Preparing for the blood draw further, the phlebotomist grabbed all her blood tubes (with their pre-filled preservatives) and pre-filled syringes of saline and heparin to flush the port before and after the blood draw.  It's amazing how many supplies are needed just to perform a simple blood draw.  What usually takes 5-10 minutes, including the numerous times that they verify your name, spelling and date of birth, this time it required nearly 15-20 minutes to complete this entire process.  But, I was in no hurry as my appointment with the doctor followed and not scheduled to start until 10:30 because she utilizes the test results to completely assess my health status and ability to proceed with the imminent infusion.

After the blood draw, I returned to the waiting area, where there were now 2 persons, other than my husband.  Chris was busily showing an elderly woman in a wheelchair, how he uses his smartphone to access information (to explain the symbols from the coat of arms on his sweatshirt, in which she had inquired) .  I could hear them chatting as I was undergoing my blood draw, but was pleasantly surprised and impressed that Chris was actively befriending others in the waiting room (this is usually what I enjoy doing and he's usually focused on his magazine, phone or kindle).  Nonetheless, this lovely woman was clearly enamored by his hospitality and we later ran into her at the infusion center where she struck up another conversation as she was leaving the infusion center and I was still receiving my medications.

No sooner had I sat down in the lobby, before I was called back by the doctor's medical assistant to obtain my vitals (weight, blood pressure and temperature).  He proceeded to take us to the exam room where he reviewed my medications, allergies and current symptoms.  After gathering the information he needed, we were left alone to read or play on our cell phones.  Given my difficulty staying focused and the 20 minute wait, I found myself bouncing between the book that I brought and reading emails on my phone.  Chris was eagerly catching up on the time-limited games that he plays with friends via his phone (such as words with friends, dice with buddies, word feud, hanging with friends, matching, and when he brings his headphones, songpop).

When the doctor arrived, she immediately gave us the good news that my counts were virtually the same as the ones prior to my last infusion 2 weeks ago.  While my ANC (absolute neutrophil count) is still at a level that potentiates the risk of infection, it remained at 0.6 (2.0-7.0 is the normal range).  Without any signs of infection seen during the thorough exam that my doctor performed, I was set to proceed.  However, we discussed my symptoms, side effects and future testing and followup prior to advancing to the infusion center.  In reviewing the insomnia side effects and the subsequent fatigue associated with the high dose steroids that I receive as part of my pre-medication, we elected to trial a decrease in dosing. Steroids are not without side effects, so we chose to decrease dosing by 40% of the usual dose of 10 mg and see if this still helps with the nausea but without causing the insomnia (I only sleep 1-1.5 hours on the Friday and Saturday nights after infusion).   The risk of doing this, is that I may have an increase in nausea or vomiting, but I can take oral compazine if this occurs in the first 48 hours and ondansetron (Zofran) after 48 hours, if necessary.

Well, by looking at the timing of this post, you probably guessed that the decreased steroid dose has not made a tremendous impact yet on abating the insomnia.   Thus far, the nausea is greater than usual but as long as I'm not moving or standing for long, it is tolerable.  If I need to be on my feet for more than 10-30 minutes, I would definitely take the oral medications or suffer the consequences.  If the nausea manages to stay at this level, I will probably try to go without the steroids at all, for the next infusion.  But, it is a balancing act and in medicine, we often have to choose between the side effects of medications and the potential consequences of not using them.  In this particular situation, neither is life threatening (insomnia or nausea) unless it leads to vomiting and dehydration, which can in turn increase the risk of infection and hospitalization.  In the back of my mind, I wouldn't mind eliminating the steroid medication because of it's GI risks (increased reflux and ulcers), association with high blood sugars and bone density risk (increases osteoporosis risk).  My pre-medication infusion still consists of 2 other glorious anti-nausea medications that are quite long acting.  Aloxi (palonosetron) has a 40 hour half-life* and Emend has a 9-13 hour half-life.  The dexamethasone (steroid) has a biological half-life at 36-54 hours (which correlates well with my 2 nights of sleeplessness).

All in all, the cancer journey must remain a malleable process.  As long as no material changes are made to the 4 active cancer-killing agents for Hodgkin's lymphoma, adjustments can be made to try to balance out risks, side effects and patient desires.  Never be afraid to mention something that bothers you in any healthcare journey or process.  If I hadn't mentioned my insomnia and the distress it was inflicting or the irritability of the pruritic rash from the adhesive, no changes would be made and I would be unnecessarily suffering. It's empowering to work with your physician to resolve treatment issues and improve the overall management of your condition, especially when the ill effects can be potentially more harmful in the long run.  

* Half-life refers to the time it takes for half of the drug to be eliminated from the blood stream, by the average, healthy person. Biological half-life is used when a drug has effects in other areas and how long it takes for half of the initial effects to be eliminated.  

 You cannot change what you refuse to confront.  

My port-a-cath in the upper right chest wall with catheter extending into the neck. 

The arrows point to the 3 dots outlining where to insert the needle into the port.  You can faintly see along the periphery, the redness remaining from yesterday's brief encounter with adhesive.  The vessels above and below the port are somewhat distended due to the catheter (a long tube that extends into the blood vessel, in this case, the jugular vein in my neck).  This decreases the caustic nature of the medication allowing it more time to mix with my blood decreasing damage to the vessel wall.

Sharing is Caring

One of the most amazing expressions of love for your friend or neighbor is providing them with a meal or a word of encouragement in their time of need.  Since I’ve never been much of a cook and am not creative when it comes to food, it’s always been difficult for me to sign up for providing meal provisions for others (my husband does most of the cooking around our house).  Yet, ever since my neighborhood coordinated a meal provision schedule for Chris and I, my appreciation for this gracious gift has blossomed further.  Not only does it provide more time for us to spend together (along with our one remaining teenage son living at home), it eases meal planning on appointment days, decreases trips to the store and decreases food aversions by avoiding nauseating smells that can occur when cooking. 

Although you might expect that we’d get sick of each other since I typically would be gone from 8 am to 8 pm on most work days, Chris and I have actually worked well together over this past month of our journey.  You see, it’s not just my journey, it’s his journey too.  He has been with me from the beginning—at every appointment, scan, surgery, and even provides for me when I’m fatigued and don’t want to move.  When my energy improves, we give each other space but work on different projects around the house or sometimes together.  In regards to our children, this time together has allowed me to help my high schooler with his physics project, arrange appointments with his career counselor, review assignments with him and listen to his presentations for his FBLA (Future Business Leaders of America) competitions.  While we had hoped to play board games together (Pandemic, Catan, etc.), I’m usually spent by evening time and it just hasn’t happened yet.  Hopefully, we’ll find time during his upcoming break. 

As far as shopping goes, I can typically get my son or Chris to pick up bread, milk, creamer and fruit/veggies that they like to eat for lunch.  But, if there is more items needed, I will wait a week after chemo when my blood counts have peaked (still well below normal, but better than infusion day).  Even after using disinfecting wipes on the germ-infested grocery carts, they still require you to pay for your groceries and no matter which line I choose, there always seems to be either a mom with a bazillion kids or an adult coughing up a lung who follow me to the same checkout.   In fact, I’ll bet there are more germs spread at the grocery store than in most doctor’s office lobbies.  That being said, I shop late at night, when hardly a soul can be found or mid-morning on a weekday when there is usually more employees than customers. 

On my appointment days, it is immensely helpful to know that we don’t have to plan or cook a meal once we return home.  Sure we could buy a pressure cooker or use a crockpot to have something ready, but then my whole home will smell and I never know how that will sit upon returning home.  It’s also delightful to know that dinner will be ready by 6:30 or earlier rather than 8 pm or later which allows me to hit the hay by 10 or 11 pm, without heartburn. 

The most incredible discovery is the realization that one is surrounded by so many loving and giving people.  Neighbors that I hardly knew have introduced themselves by bringing a delicious meal with such creativity and compassion that uplifts the soul.  Our exposure to new dishes and flavors is not only refreshing but helps avoid the monotony of our own, typical meals.  It also helps me avoid food aversions to the foods I normally enjoy.  In addition, we learn new recipes such as a homemade granola made with seeds, nuts, oats, coconut among other ingredients (see recipe below).  There are even websites available now to help coordinate meal provisions:   https://www.takethemameal.com/ which allows the coordinator to document allergies, likes and dislikes and is loaded with meal tips and ideas.  One neighbor brings smoothies to help me disguise the chalkiness of the glutamine with tasty fruit and yogurt combinations and provides a snack pack for Chris and I for infusion days.   It is very heartwarming to experience such kindness and I can’t thank you all enough for all the meals, cards, letters, gifts, blog replies, amazon deliveries, Facebook messages, and so on that keep encouraging and providing hope!  When you watch a sad story or see something horrific on the news, I want you to always remember that there are so many more good people in the world and this experience is just one of those reminders to me.

The greatest feeling in life is to make a meal and share it with people.  ~ Rachel Ray

You must not lose faith in humanity.  Humanity is an ocean; if a few drops of the ocean are dirty, the ocean does not become dirty.  ~ Muhatma Ghandi (another one of the great leaders and peace makers of my era, along with Mother Teresa and Nelson Mandela)

Mix ingredients and bake on a large cookie sheet in a thin layer at 300 degrees for 45 minutes, stirring every 15 minutes.