Risks and Scenario Planning

The amazing thing about my poor burned arm is that, actually, as disgusting as it looks, all the blistering and peeling suggests I've begun to heal from the radiation treatment.  I guess what I didn't realize when I was told that my arm would get worse (after the treatment ended) before it got better is that this didn't just mean it would be more painful/swollen/red (indicating I had reached maximum dose, and active cell destruction, with maximum white blood cells dispatched to fight the killing), but that it would have to go through this blister/peel phase that would make people avert their glances.  I'm assuming that by the time my mom shows up a week from Friday, it's going to look like no big deal -- as it did two weeks ago.

I saw my internist yesterday (at a funeral service for one of Ben's schoolmates' mom's -- which is a tragic and shocking, but different story).  She said the radiation had probably killed all of the cancer cells left after the last surgery.  Which leads to the obvious question:  If the radiation "cured" me, why have another surgery -- especially one that will result in some level of permanent disability? 

On the one hand, if the radiation killed all the cancer cells, then it would seem that I've had enough, successful "treatment."  On the other hand, there's all the scary information (which some, like Sue Levy, say I shouldn't be reading in the 1st place) about wound complications, trickiness of reconstruction and levels of permanent disability from a surgery in the forearm where there isn't a ton of tissue, but the surgeon still needs to take a safe, i.e., wide, margin around a sarcoma.  And, there's the data on soft tissue sarcomas still resulting in a high level of amputations, because, to me, 15% is high, even though it's down from 70% two generations ago.  Finally, there's the pathology report which says (confirmed by literature) that the risk of this kind of soft tissue sarcoma metastasizing is quite low.

With all of these factors, how do we (me & my family, notably Bill) weigh surgery, with its certainty of some disability and a small, but still real risk of recurrence, against the slightly less small risk that there's cancer left in my body that will now start to regrow.  The medical literature and traditional Western providers are in complete agreement that doing the 2nd surgery is a no-brainer.  But if there's no sarcoma cells left, and they were of a type that is highly unlikely to metastasize (and kill me), then why not wait to see if the cancer returns, in which case I could have surgery then, and not commit to some level of permanent disability for the next 40 years? 

Nobody freak out -- I'm not suggesting that I'm abandoning the current plan.  Maybe it's having spent the last two days considering lots of scenarios with my colleagues in a work context -- something we do all the time.  We're always pushing and engaged in scenario planning.  So aren't there a couple scenarios here?  Is there a risk that's small enough that would change the calculation?

no good deed ...

I've had two conversations w/ my good friend Barbara ("Aunt Barbara #2," my college buddy, not my sister in law, although I've also talked to her) in the last two days.  She's coming to Houston to help me there, and as a result of my call last week w/ MD Anderson, she's going to have to change her plane tickets (because of their saying I'm going to have stay in Houston after I get discharged from the hospital), which she bought nice and early to avoid having problems.  Of course, she's a mensch now, refusing even to discuss how this glitch is costing her hundreds of dollars more than she paid initially.  It's part of why I'm so mad at MD Anderson!

The other conversation was about the photo of my arm that I posted yesterday.  After saying, "Yes, show me, I love gory stuff," today after looking at yesterday's post, she said, "OK, maybe I don't really want to see YOUR blood and guts."  So I apologize to the rest of you.  And I apologize to all of you who I've seen in person (like Linda from Ladies night) who are NOT interested in feeling how hot my arm is.  For all of you who I've offended w/ first hand yuck, I apologize.  I can't say that I'm going to stop posting, or offering, but I'll try to be more understanding that not everyone thinks looking at the photos (or real thing) is fascinating, or even warranted!

On a more everyday note, it drizzled most of the day, and was cold, but Val and I still walked (Dakota Ridge) and she didn't seem to be complaining much.  I went to Denver to teach the water quality class to Star's DU Water Law Students, which is always fun.  Scott dropped by (he's in town for Colorado River meeting the next two days) to have a drink and hang a bit before he went to dinner w/ fun friends, also here for those meetings from out of town.  Always great to see him, especially for Smokey, who lets Scott handle him in ways he won't let anyone else (at least without biting).  And, per Ben, Wendy brought chocolate, after checking out the photo in yesterday's blog.  See above ...

zombie

When I had surgery on 8/1, I came home w/ a pain block, but after it wore off, I took exactly one pain pill, of the 30 of so prescribed.  This weekend, however, I've taken several.  Odd how the pain of the radiation side effects is substantially worse than a tumor extraction & skin graft.  My arm is so swollen that it feels best when I rest it on my head!  (i.e., elevated.)  But mostly it's just shocking to me that something as localized as the radiation on my arm (7 cm laterally from the excised tumor -- so from a inch or two above my wrist, to just above my elbow) can hurt so much.  The need to be distracted is every bit as extreme as the pain.  And, as predicted, my arm looks -- and feels -- a hell of a lot worse since the "treatment" stopped on 10/22.  I'm pulling for the techs to be correct insofar as they said it would probably only get worse for 5-7 days (and I'm advocating 5), before it started to get better.  Sadly, I'm really too distracted to be able to post anything else. ...

MD Anderson is all about teams.  And the description I got in August, and that should still be valid of my upcoming surgery in December, is pretty impressive -- 3 docs in the O.R., a cancer surgeon to remove the cancer, a pathologist to confirm it's done, and a plastic surgeon to put me back together.  I just wish that they could be as seamless about logistics.

I had a disconcerting phone call w/ my "patient advocate" in Houston today.  She seemed almost annoyed that I had called a few days ago to try and get more info about when I should make plane reservation to return to Colorado after my 12/11 surgery.  She reported that the plastic surgeon, who has control over the post-op care, agrees with the cancer surgeon that I'm likely to be in the hospital for 3 to 7 days -- except he's saying likely 7 days.  What she added, though, was new information for me, and not something the cancer surgeon's team had previously shared, or thought to share:  I should remain in the Houston area for a week after discharge to make sure that I have access to MD Anderson if there's any complications -- or if I need follow up appointments or treatments (not that they can say now that I will, or won't) -- because "our doctors don't practice medicine over the phone).

In my case, that means that I'm looking at being allowed to come home from Houston on 12/24.  Wouldn't it have been nice to let me know this previously?  Or, at least, not to have sounded so annoyed that I'd asked the question today now that it's getting to be time to make reservations?  Not that our family celebrates that holiday that occurs on 12/25, BUT even for us, it's a big cultural event.  A great day to ski (especially in the a.m.)!  From a more national perspective, it certainly affects not only ticket availability, but the cost of plane tickets. The patient advocacy part of her job seems to have broken down a little.

Meanwhile, my arm is blistering.  Mostly, though, it's just really damn hot.  I did get another couple cards today.  Plus, one of Bill's friends brought dinner, which was not only yummy, but I didn't have to cook!

Ben was so flu-ey (congested, sore throat, runny nose, low fever) that he came home after two classes today.  He slept for 4 hours.  Then, while he was announcing that he felt better, he suggested that he should go to the football game.  I, on the other hand, suggested that, if he was too sick to be at school @ 3:30 pm, he was still too sick to go to the football game at 5:30.  Call me crazy.  Or a stick in the mud. Really?!

Ladies Night Birthday

As many of you know, I am part of an amazing group of women who gather on a weekly basis -- and have for 25 years -- to be with each other and discuss the week.  Our husbands think we talk about them, but honestly, this is not the case (although it does happen).  And we don't just talk about our kids, although sometimes one or more of us does.  Sometimes, although not every week, or even  every month, we talk about current events, especially around this time of year, when we sometimes bring ballots and discuss our civic duty.  That wasn't the case this evening.  Sometimes we discuss our moms.  And there's lots of weeks when we talk about our own challenges and opportunities -- work, personal, and social.

Tonight, we were at the Boulder Outlook.  There was a blues band from Israel playing. We all agreed that the lead singer, a  beautiful, slim young woman with long wavy dark hair in a Tibi dress, who sounded like an older larger Hazel Miller type woman, didn't sound Israeli, or even at all like a woman who looked like she did.  But, isn't that what's great about voices? In fact, I was listening to her during a break and she sounded Southern.  But it was fun.  After we got tired of not being able to hear each other, we went outside of the bar/music venue, into the hotel atrium by the pool, and played pool.  Donna is good, the rest of us, not so much.  But, we had fun, because we're the ladies.  Not great pool (someone -- i'm not going to say whom -- knocked the 8 ball, with her hand, into a hole to end our misery!), but honestly, there was no one else there, no hot group of guys waiting to compete, so who cares?

To continue the warm, fuzzy theme that my husband established for my birthday present, Marilyn (my angel) got me warm fuzzy socks and a warm fuzzy scarf.  Yea!  Plus, I got two cards in addition to the one from Ladies Night.  One from my mom (I won't even say how upset she'd be if I sent her a card that was two days late) and the other from my friend and former colleague Laura in MT.  So sweet, both of them.  Never mind, the two emails I got today, as well as a phone call.  One of the emails was from my first friend -- from nursery school (how many of you remember when we that's what we called pre-school) -- with whom I've barely corresponded in decades.  I've re-read it several times.  The phone call was from a woman who started a Colorado enviro group, who is one of a cadre of women that my cohort all think of as role models, and here she is telling me I was a roll model.  I almost cried.

Meanwhile, my arm is getting redder and hotter and more bothered.  Aargh.

all done with this phase

This is what a fully radiated arm looks like -- swollen and burned, but done!  Gave the techs gloves from Title 9; Ben said last night, "Why do they get presents, Mom?  They were just doing their job." But some jobs are hard (how can it not be depressing -- Debbie Rothley, Halley Nagiah -- to spend all your time every day with cancer patients).  And they were very sweet.  They want me to come back and show them my arm post surgery.

Took Val for a walk in the glorious fall sunshine when I was done.  Then I came home and sat at my desk and apologized to all the folks who sent me emails about the spam that went out from my account this morning at 3 am.  I did wonder whether some smart ass spammer chose me because s/he was cruising Facebook looking for birthdays.  What a present!  I did get beautiful flowers from my brother and sister-in-law, plus cards (including the instant classic from B Dau, who always manages to find amazing cards), plus the softest robe ever -- Ben wants one out of the same fabric.  And, yesterday, this mystery jar of mustard from Napa Valley, where both of the Uncles Michaels have been in the last couple weeks, although each denies having sent it.  And body butter from our 'always there' across-the-street neighbor, Laura Ghayur, who really is always available to help out w/ dog and child and who brings

Later in the afternoon, Bill and I went to school conferences.  We saw five of his six teachers over the course of a couple hours that Marilyn Cohen (of Ladies Night) once called teacher "speed dating."  Of those, five think he's great -- notwithstanding that he's woefully behind in his homework.  Only one -- ironically the youngest and newest to teaching -- remains someone to whom he needs to prove himself.  And even that guy told us a story about Ben making a social decision that would be beyond most 9th graders' capabilities.  Now we just need to get Ben back to a happier and psyched place, where he both gets his homework done and looks forward to going to class.  Not a small task, we know, but this afternoon was somewhat reassuring.

After conferences, we picked Ben up at climbing and went to Zolo's for dinner.  We had a nice time as a family, which given how cross-wise we all got yesterday, was nice.  (Yesterday, Ben told me that everything I did was annoying, and I pointed out that was without my even trying to be annoying -- imagine what it would be like if I TRIED!)

Finally, there's been some amazing email traffic on the ACOR sarcoma blog.  First, Mimi (grandmother to everyone) posted a new article yesterday on reconstruction of soft-tissue sarcoma on the forearm.  If soft-tissue sarcoma is 1% of all cancers, soft-tissue sarcoma below the elbow is apparently 1% of all soft-tissue sarcomas.  Lucky me to have something so rare.  The article (out of Japan) was about the difficulties -- and successes -- in doing reconstructions on the forearm and hand, in part given how little flesh there is compared to how much structure (muscles, tendons, veins and bones).  Thus, the likelihood of ending up with real damage once the safe margin is taken.  The authors discuss using a lat or a muscle that runs along one's inner thigh (the gracilis) to do reconstruction.  Sort of unbelievable. 

Then, there was an exchange that started with Mimi posting and asking about experience or technology for dealing with "deep wounds."  There were a number of posts, and then someone piped up to say, she knows people spend a lot of time trying to avoid amputation, but she lost her leg two years ago and she's learned that she can do everything she needs to and even that she was used to doing, albeit in a different way now.  So she wonders why she fought so long to avoid the amputation.  And she's talked to lots of other amputees who feel the same way.  Safe to say that that post totally shut down the thread.  Funny in a sick sort of way.

Tomorrow is "graduation day"

The techs call it my "graduation day."  Tomorrow will be my last treatment.  They said to expect the side effects to continue to get worse maybe through the weekend and then start to abate.  Because the beams are killing cells that are growing, cells that get zapped tomorrow will be dying (and the good ones, we hope regenerating) for several days after, which is why the symptoms, now including chills, in addition to swelling, itching and local pain, don't stop immediately.

Meanwhile, I'm still waiting to hear from the plastic surgeon's physician's assistant.  If he doesn't call by tomorrow morning, I'll call my patient liaison to try to get him to talk to me.  I bought a plane ticket on the hope that I can come home when I'm released from the hospital.  Hope that turns out to be true!

good thing there's only two more

The radiation tech commented on my arm being swollen and the Doc examined my arm for a while, but ultimately said it was good that I'd get the weekend break, and then also only had two more days.  Safe to say that it's hot, bothered, itchy and sore, which all indicates, of course, that the radiation is working, i.e., killing cells.  So my body has sent in the white cell marines.  At least I can supplement with Tylenol (but not ice, because they want it to be hot).

Meanwhile, I called MD Anderson to try to get someone on the reconstructive surgeon's team to call me back.  No luck today, but maybe Monday.  I'm trying to figure out whether I can come home to Colorado when I'm released from the hospital, or whether I'll need to stay in Houston.  With the surgery in August, they put a cast on the skin graft site, to protect it, and I had to go back after one week to get the cast and special dressing changed, and then the next week for the stitches and another check.  But that was outpatient surgery.  This will be more complex, I'll be in the hospital for longer, but from a planning standpoint, I don't want to be released from the hospital at day 5 and fly home if I have to return to the hospital on day 7.  And, given that a week out is 12/18, obviously lots of air travel after that will be happening during the "holiday season."  The cancer surgeon's physician assistant has no idea what the protocol might be, and I've not had a face-to-face consult with the reconstructive surgeon, so if I can't get some basic idea from his PA, I may need to go down there again to get more info.

We woke up to snow today -- about an inch. But it was sunny all day, so most of it is gone, and the weekend is supposed to be sunny and back to 60 degrees.  Our maple and catalpa tree still have most of their leaves, so the maple's boughs were touching the ground in the morning; now they're lifted.

I'm so tired ...

cooking

4 more radiation treatments.  One of the things I notice now about my arm is how HOT it is.  Just like a really bad sunburn.  It's woken me up the last few nights.  Of course, the directions say do not apply cooling to it, b/c this is part of the treatment.  Certainly seems to be cooking inside there!

6 more

I went to radiation this morning, and then took the pup to the groomer this afternoon.  She's much more acceptable to the humans in the pack now -- washed, trimmed, teeth brushed, de-burred, etc.  Allowed back on the couch in my office.

My mom called and wants to come visit -- "to put her arms around me."  I'm trying to decide whether I should go to Cleveland or let her come here, given how much I know she doesn't want to travel.  Need to discuss w/ B&B to figure out which is less stressful for us.

With no school today, Ben did a bunch of Spanish homework, after having done science and math earlier this weekend.  We're all looking forward to the day he'll be caught up -- which we all think could be tomorrow or Wednesday.  As Bill says, it would be a most excellent birthday present for him.  Not that we're doing much of a birthday celebration.  He's going to his Best of the Best CEO Exchange group tomorrow (like his Ladies Night, they've been meeting for decades now, albeit a couple times a year as opposed to every week), so we'll celebrate Wednesday.

We woke up to a thunderstorm this morning, which is really unusual.  Thunder is almost always a late afternoon/early evening event in Colorado.  And then, at 7:45 am, it HAILED.  Good thing Ben did have the day off from school because that's just when he would be riding his bike in the morning.  My car windows were cracked, so when I left for radiation, there was a pile of tiny little hail stones on the passenger seat.  Crazy!

Val, the Dog

Everyone in our household is stressed.  Ben is stressed about homework.  I'm stressed about the Big C, and the fact that Ben has so much homework.  Bill is stressed about many things, including the ones already mentioned.  What's interesting is that Val, our dog, who expresses her stress through her GI track, is also stressed.  She's not even wolfing her food down, as per usual; sometimes her food sits for hours before she eats.  But I had to use four bags on our walk today.  Tomorrow, she has an appointment with the groomer, because, as Ben said, she wreaks.  It's fascinating to me how she absorbs the stress level in the household.  I guess there is one being in the house who isn't stressed -- Smokey, the cat.  At least he's eating his normal voluminous quantities.  Ever the iconoclast!

mild side effects & the costs of medical care

The side effects are beginning to pile up, although they are each mild.  My arm is looking pretty sunburned -- we can trace the line from the radiation on my arm, like some weird bathing suit strap line back from when I used to try to get tan.  Plus, it itches.  I'm slathering on copious quantities of the Tulipan cream they gave me. 

The fatigue is also appearing pretty regularly (mid-afternoons).  Naps don't provide relief; I guess because it isn't from being tired due to loack of sleep. I can stave it off if I'm highly focused on something else.  I used to like to do the hardest work in the mornings because that's when I feel like I'm the sharpest.  But for the next month, I guess I'll just have to reverse that. All that said, if this is the worst of the side effects, I'm lucky.  Seven more radiation treatments to go. 

I got a statement from my insurance company yesterday.  The cost of the radiation treatments is pretty stunning, even with the 2/3 discount that the insurance company gets.  No wonder getting cancer can knock folks out of the middle class.  I appreciate that these machines are amazing and super high tech.  And, especially after looking at these charges, I'm so appreciative that I have insurance that covers me.  But the numbers are stunning.  One day's worth would be a big bill for most families, and my course of treatment is 25 days worth of these charges.  Never mind the costs of the surgery in August and the tests done in preparation for that. Or, the costs for all the tests that were done to get ready for my 1st MD Anderson appointment and that will be done again before surgery in December.  And the costs for the next surgery will likely be extraordinary, because they will have three specialists in the O.R.:  the cancer surgeon, the pathologist and the reconstructive surgeon.  So easily six figures, just for that day. 

Every day that I get an envelope from my insurance company my anxiety spikes, as I wait for the one with the letter saying they aren't going to continue my coverage into 2014, or that they're going to double my rates.  I know that the whole pre-existing conditions term kicks in next year, assuming that the President stands firm on not negotiating reductions to Obamacare, but -- just like what we went through with Bill's knee replacement -- it's still nerve racking.

Meanwhile, Ben's in the basement doing homework -- let's hope it's actually getting done.  And tonight is the homecoming dance.  Bill was talking about how complicated that always was.  And how the whole teen dynamic just makes it complicated.  It's funny how it wasn't complicated for me because we just didn't go to many dances. I went to more in junior high -- I think I went to exactly one during high school.  So it wasn't even an opportunity for angst.  We were too cool and out doing other bad girl things on Saturday nights, especially in the winter after the hockey games. 

wait & watch

So the consensus from the Docs seems to be that the new bruise on my arm is not some nefarious underlying cause, but a bruise.  (Sometimes a cigar is just a cigar.)  Apparently, radiation therapy on a lower extremity (i.e., below the knee or elbow) routinely causes bruising in people who are prone.  That said, both the surgeon who did the initial surgery in August and the radiation doc said to wait and see whether it clears up on its own, w/o leaving any evidence behind, over the next few weeks.  So that's what I have to try and do.  At least I'm 2/3's of the way done.

Meanwhile, I got my hair cut short -- Debbie Rothley or Liz Storer style.  Curly girls don't get "pixie" cuts -- they requires straight hair.  My hair looks like it did after I got it cut the spring of my senior year in college because I wanted to look grown up.  Hasn't been this way since my 20's.  It will work well for the month that I'm in a sling, and it doesn't look bad (Ben said, "nice haircut" but given that he'd been so angry he wasn't speaking to me the day before, I'm not sure exactly how to take the comment), but I'm not sure I'll keep it after I'm two-handed again.

The whole business with Ben is distressing, and there's been more snapping in this house than ever before.  We have to be careful not to degenerate into full bore negativity -- especially not now that we most need the power of positive thinking, and notwithstanding that we appear to be standing not at the threshold, but in the middle of classic teen-dom.  With homecoming this weekend, no less -- oh my.

lump

Last night, after I wrote in the blog, I was moving our big, heavy toaster oven and hit my forearm, just below the graft, on the corner of the cupboard.  Not a big deal.  The sort of thing, though, that in the old days -- back when I had a venous malformation on my arm -- might have caused a little lump. 

Guess what?  it caused a little lump!

 

Now what's alarming about this, of course, is that, back on August 1st when I had surgery to remove the tumor from my arm, the whole point of the surgery was to remove what was causing my arm to get these lumps. 

 

I understand that this new lump isn't cancer. So, it isn't an immediate threat to my well being.  HOWEVER, if the sarcoma was a "transformational" tumor, i.e., it was damaged tissue that wasn't cancer, but somewhere in the last five years became cancerous, then I would like to feel that all this treatment should not only eliminate the cancer, but it should eliminate the cause of the damaged tissue that turned into cancer.  That would mean eliminating the source of the problem.  so it wouldn't happen again. 

 

Eliminating what makes my skin go lump in the night.  Bill and I both just stared at this lump last night, trying to grasp that it had happened again.  And, sadly, both my internist and radiation oncologist said I needed to talk to the MD Anderson team.  Yet, for the first time that I've left them email and phone messages, they didn't call back.



driving

So many people tell me I'm tough and determined, I just believe them and wipe all doubt aside.  It's just how to turn off that little voice off to the edge of consciousness, barely audible.  And yet also somehow dominant, like the white noise that becomes Chinese torture rather than background.

Early radiation was fine -- the radiation techs seemed genuinely appreciative for the socks ("We love Smartwool!"). 

The drive down to Colorado Springs wasn't bad.  I missed the 1st two panels, but I think that was OK.  It was a lot of economic theory.  Everyone who needed to see me (who'd invited me -- or highly suggested I come) saw me.  Told the Cowboy about my sarcoma.  Good doctor's son that he is, he asked some discerning questions and looked worried. Eventually, he gave me a big hug; he's like an upright couch -- very comfy.  Talked to Jim B, who had cancer a while back, but recently had a heart attack -- now he's eating vegan, walking during lunch and has lost 17 pounds in a month.  He didn't even eat the salad we had at lunch, b/c he's being that careful.  Maybe I'll get there, although that's honestly as hard to imagine as being seriously disabled.  Talk to a couple other ag guys, all of whom I'm friendly with.  I said to Bill I thought a couple of them, with whom I jousted a decade ago (or more) have matured, just like I have.

Had a drink w/ Dan K.  Always good to hang out, build bridges, and besides, if I'd left right after the conference, it would have taken 3 hours to get home (like Sunday night coming back from Vail).  This was much nicer.  Again, I remember the first time we met, on a Water 2025 panel. I said something snide about Klamath and he railed against enviros, all of whom used ESA litigation to attack irrigators.  We were most definitely not friends.  Today, we traded Reclamation and other DC gossip, compared notes about some of the folks who spoke at today's conference, and shared stories of the worst years of our lives.  What a difference a decade makes.  Plus, we spent just the right amount of time that the drive home was painless.

A full weekend

It was a beautiful day today.  I hiked Sanitas w/ Val and Vicky M.  It was a little crowded, because so many trails are still closed due to the flood.  But great to get out.  Especially since yesterday, Annie and I (and Val and Luna) did a small loop at Chautauqua. 

So I wasn't without energy.  But I'm exhausted now.  Maybe I didn't get enough sleep.  Maybe there were too many pink drinks and port at the Ghayurs last night (which was lots of fun).  But it's seems like I've been tired for no reason each of the last couple days.  I went to a retirement party for Paul Frohardt this afternoon in Denver.  He's been at the Commission since 1987!  There were lots of water quality junkies to talk to, including Mely, who had a 7 week course of radiation.  She said she was more tired for the two weeks immediately after she was done (i.e., after getting the full dose) than during the treatment. 

Tomorrow is the day that Tiffany and Candace, the radiation techs, are opening early for me.  Then I'll get on the road and drive to Colorado Springs to spend the day thinking about the value (and cost) of irrigation water, with a bunch of economists and irrigators.  And here's hoping I'm not too tired to drive home!  Because that would be awkward.

Ben has decided that his failure to do any homework for the first month of school has more to do with a lack of motivation than a lack of executive function.  His solution is that he needs an outside goal to provide motivation.  Bonnie, his coach, suggested two, one negative (avoid summer school) and one positive.  He announced that he thinks we should buy him a computer, so he doesn't have to borrow one of ours, if he gets caught up and stays caught up doing quality work.  With the 1st night of Chanukah falling on Erev Thanksgiving this year, we think that's fine.  Bill's only worried what we'll do if he doesn't make it.  But this is like everything else now; I have to believe the positive version of the story.

Yesterday afternoon was a great Boulder, my fair city, kind of day.  I was doing errands (like buying a fish for Paul's gag gift and the cute Smartwool socks for the radiation techs) when I ran into Jim Martin, who I hadn't seen since he started his new job; we sat outside the Brewing Market and had a cup of coffee.  As we were getting up to leave, an intern of mine from EDF who I hadn't seen for a decade probably came over to visit.  And then Vicki Kurzban and I went flower shopping  (I got pansies and poppies).  I went back to her house and she dug up a bunch of irises that were overgrowing her yard to give me.  Very cool.  I wanted to plant them today, but didn't have time, between Sanitas, groceries and Denver, so I'll do it Tuesday am.  Get to take out some more grass!

52%

Today's the half way mark for radiation treatment. My sister-in-law sent flowers (which are gorgeous; she said she picked a "modern" arrangement.  Whatever -- bamboo and dendrobia -- stunning).   Hurray.  A mile-marker in this process.  And, I heard from Angela today about my schedule for MD Anderson pre-surgery.  It's funny.  They set a 15 minute appointment with the plastic surgeon -- who does the all-critical reconstruction.  It will be our first meeting w/ him.  No wonder MD Anderson is always hours behind schedule.  I do think I'll call the PA and suggest that we might need a few more minutes!

The radiation therapy techs very kindly scheduled me for an early appointment Monday morning to accommodate my need to drive to Colorado Springs for an all day meeting.  I was thinking about what I could get them to express thanks.  Yesterday, I noticed a huge plastic dome at their work station; it was a coffee cake one of their grateful patients made them.  Today, as we were confirming the special time, I couldn't help but notice two boxes and four bars of chocolate!  Guess I need to get something other than sugar to show my appreciation.  If not flowers, maybe socks (since Tiffany runs and Candace climbs).  Candace's husband is going backpacking this weekend.  Oh to be young.  All I could think about was that it snowed today (we woke up to white frosting on the trees) and that it would be a totally different experience to be backpacking this weekend -- and what I'd need to bring to stay warm.  And, of course, the weekend before wouldn't exactly have been a hiking picnic, what with the torrential rains during the second wave of the flood ... I am no longer able to accommodate such swings.

Last night was Ladies night.  Two ladies bought me glasses of wine (the server wanted to see my driver's license -- which I did not have with me -- to prove I was over 21).  One lady said she was concerned I was perhaps too cheerful about my situation.  But not only did the server bring us gratis cookies (to get us to leave at the end of the evening), but I've got dates this weekend to go to the garden store and shop (buy bulbs) and hike.  Gotta love my support network.

The snow today was great.  Fall is here and winter's coming.  Ski season.  Bill made hot chocolate after dinner tonight.  I drank about 10 cups of tea today, including a pot while meeting with my colleague and friend Brad, who's having an interesting journey of his own, assessing what he wants to do with his life, in the aftermath of his brother's death this summer.  Funny -- but serious -- about how life intervenes.  Also demonstrated, of course, by various friends' furlough experiences.  My favorite of these is Andrew's, my former TU staffer.  He's running every day to a fishing hole, fishing until he lands something, and then running back and having a beer -- taking photos of trail, fish and can each day to document his day.

Lots of other thoughts, but this seems pretty random, and possibly boring, so I'll stop. 

Got a decent (for me, anyway) night's sleep last night.  Walked the dog on our "usual" weekday loop (Dakota Ridge - Goat Path - 3rd St).  Ate breakfast and lunch.  Felt tired this afternoon -- and still feel tired now.  Wondering if this is the dreaded fatigue setting in.  I'm two weeks in, so it would be "on time."  Still, hope not.

Meanwhile, enlisted the Rabbi, who promised to call and check in w/ Ben.  He also wants me not just to worry about/care for other people, but to make sure I spent time on me, too.  I actually think this is somewhat ironic advice, coming from a rabbi -- who spends all his time focusing on his congregation.  It made me smile.

Made mole (with an accent -- can't seem to find that in the formatting bar) for dinner.  It's simmering now.  Bill's favorite and something we all like.  Yum.  And this recipe makes enough for two, so we can have it again next week over something different.

40%

Bill came with me to my radiation therapy appointment today.  He was, of course, delighted and fascinated with the machines and the tech, generally.  Loved it.  We met with the Doc who proudly took us to his office to show us the "plan."  This is cross sections of my arm with the radiation dose imposed through swirling colorful lines.  There's only a few place where the highest doses cross the bone; however, there's points both down near my wrist and in my elbow.  And, throughout, there's the secondary dose lines that cross those bones.  So, on the one hand the radiation is highly likely (my friend Deb Rothley talked to her radiation oncologist co-worker who said 95%) to kill the cancer cells.  On the other hand, there's these long-term side-effects.  And when Bill says, "well, you'll just avoid falling on that arm/elbow/wrist" he's speaking as an athlete who might both think of that on the way down and be able to avoid it.  Not sure I'm in that group.

The good news remains that, so far, other than some GI track issues, I'm not having immediate side effects yet.  No fatigue, no sunburn.  Yea!

The hardest part of today was my state water committee meeting, where I had to talk to (and tell) a number of colleagues who didn't know about my cancer.  That's always hard.  As I've learned, I'm able to have one conversation a day.  Two maybe.  Brief mentions more than that may be possible.  But to have to go through the story multiple times is hard.  Especially when the person I'm telling wells up.  On the one hand I so appreciate that my colleagues and friends care enough to be surprised and saddened, it's hard for me to have to go into comfort mode for other folks.  Admittedly, it's easier now than it was a month ago, but it still isn't easy.