Friday, February 29, 2008

Flight or Fight

I let the fear get to me yesterday. It reminds me that we all live in a precarious state of only marginal control. My own panic about cancer, though superficially scarred over and starting to heal underneath, is still pretty close to the surface. Bill says "there is no fairness, and precious little mercy, where cancer is concerned," but we still have life, and hope, and faith on our side. We have new trials, skilled docs, brilliant researchers, and new treatments. We have some time, and we have prayer.

So much of what we do as humans is misdirected or futile. But occassionally, we are called to war against the darkness with every bit of strength we can gather. I actually have a picture in my mind of what this carnivorous beast looks like, having caught the shape of it in some of my most terrified times. We all come to a point where we want to run and hide, but somehow we stand and face it in spite of ourselves, and keep fighting.

R & D will saddle up and start the battle again, and I'm going to have faith that they can win it. I'm putting them inside a protective cocoon of woven light where they can be the victors this time.

Thursday, February 28, 2008

Bad news from an old friend

All I can think this morning is "please, no." My close friend from college days called last night to tell me that his cancer is back, metastasised in multiple sites, Stage IV, the diagnosis we who have had it once dread, and yet always half-expect.

I wanted to scream at the heavens and rend garments, keen on the floor and howl at the moon. I curled up on the couch and cried myself to sleep instead. I only know what it's like to have an initial finding of cancer and go through a few long months of anticipating and steeling for the worst--I can't really comprehend what the finality of such a diagnosis feels like for him and his family. To have gone through multiple surgeries and chemo twice over the last 3 years, and then have to face it again, this time with a flashing "FINISH" line the only sure outcome?

I don't even remember the first time we met, but it was in the first few weeks of freshman year, when we were both 17. He eventually became my roommate's boyfriend, but the three of us were inseparable for two years--studying, partying, day trips to the mountains and weekends camping on the beach. When he moved to San Francisco, I made trips to visit, so we could still talk long into the night together. I was at his wedding, and then his graduation from medical school, celebrating with them. He and his wife had their first child shortly after Bill and I had ours, and the four of us would get together and laugh through our mutual parenting experiences of sheer wonder and overwhelming exhaustion.

Then, somehow in the crush of busy family lives, we lost track of each other for more than two decades. Last summer, I tracked them down when I drove out West, determined to reconnect, though at the time, I didn't know why I felt it was so urgent to do so. When I was diagnosed, he and his wife talked me through the panic-stages, having been through it themselves, having emerged on the other side. They told me it was all going to be all right.

But it's not all right. I'm fine, and his is back, and there's only a vast, gaping abyss in my heart this morning, a grieving that I can't imagine will ever stop.

Wednesday, February 27, 2008

Snowed in...

I woke to a White World this morning. Having neglected to check the weather forecast last night, I am paying the price of inattention. I'm snowed in this morning. I will have to wait for sunshine to melt the driveway in order to go anywhere, and that may take a day or two.

I've got everything I need up here on the mountain. With a little Barber or Copeland on the stereo and Netflix movies to watch, I'll be just fine. I've got plenty of chores to putter with, plenty of small projects to keep me occupied, while I watch the big, fat flakes of wet, late-winter snow swirl around outside my windows.

I am content to wait for the world to start up again on its own timetable.

Tuesday, February 26, 2008

Rainy day napping...

My appointments went well this morning, but I came home and collapsed anyway, and spent the rest of the day dozing on the couch with Echo, who also slept.

Dr. Huddleston has scheduled my surgery for a week from Friday, an encapsulotomy to loosen the "Iron Maiden" feel, and correct the cosmetic cleavage defects from the original reconstruction. He says the surgery should take about an hour. MaryAnn will be my surrogate Mom for this procedure, and drive me over and back--thank you!

Dr. DaSilva offered Effexor to mitigate the hot flashes, night sweats and depression. For the moment, I want to avoid adding another medication to my profile. I don't want to get into the cycle of taking one drug, then another drug to treat the side effects of the first drug, then another to treat the side effects of the second, then another, etc. I've seen this happen way too often at the pharmacy, and told him I wanted to continue to monitor my reaction to the tamoxifen for another 3 months before considering more.

Appointments in Kingsport

No time to spare, I'm off to Kingsport for the plastic surgeon at 9:30 and the oncologist at 11:20.
I'll try to post when I get home this afternoon.

Monday, February 25, 2008

My New Voyeurism

I notice every woman's breasts now. Not in public, mind you, but only because I stay pretty close to home. But in every movie or television program I watch lately, I find myself checking out all the women. It's so weird, like suddenly being transformed into a 13-year old boy who's discovering breasts for the first time and can't stop staring.

When I've told people I've had breast cancer (or a mastectomy), it's uncanny how their eyes start to dart southward, then the brain kicks in, dragging their gaze back up to my face. I have never had so many people look me straight in the eyes--I can almost hear them yelling at themselves, "don't look, don't look!" Now I find I'm the one who is looking all the time, trying to get a sense of where I fit in, what I look like now to the outside world and to myself.

If a character is wearing a sexy red dress, I'm checking out how low-cut it is, assessing whether the same dress on me would cover my scars. If she's wearing a sweater, I'm wondering what her bra size is, whether I am now larger or smaller than she, comparing what I was before, and now, afterwards.

Having gone through 40 years of being the biggest bosom in the room without consciously dwelling on it, I'm trying to get used to suddenly being average. And, as stupid as it sounds even to me, I wonder if my figure still qualifies as "nice" without the impressive rack. I'm sure this is a consequence of a little too much self-absorption; just a temporary disconnect between the body image in my head and the reality of my new, less-than-half previous size.

Part of me understands the general attitude of the young residents at UVA, which seems to be "well, who's going to be looking at a 55-year old woman anyway?" I know the cluelessness and arrogance of youth--I've been there, thanks. They see a middle aged woman, but I still think of my body as what it was about 20 years ago. Being forced to redraw that picture in my own mind is a chore, but probably not an insurmountable one.

Objectively, this new me is more proportioned and much more physically comfortable than the old me. Now that I am not dealing with the constant, gripping pain, I'm hoping to become much less self-conscious. As odd as it is to notice how fixated I've become, my looking at everyone else is probably just a way to regain some integration between what was, and what is.

Sunday, February 24, 2008

I can feel Spring coming

I'm smelling anticipation in the air this morning. I'm hearing birdsong increasing daily, and even a stray peeper frog piped down at the pond last evening. It feels like the earth is gathering itself up, getting ready to burst forth in greenery any minute.

I was never enchanted with Spring when we lived in New York--a grim, schizophrenic season of rain, mud, ice, fog, gloom and false hope, lurching from freak snowstorms to summer heat and back again, gardeners wary and suspicious all the way up until Memorial Day. Not my favorite time of year there.

Here, it's a kinder, gentler and much longer season that brings delight and discovery with each passing day. There's a progressive rhythm to it, which I'm still figuring out. The wildflowers each have their days in order, the flowering trees like dogwoods and redbuds bloom and linger. Then, the blackberries and raspberries that grow wild all over the place will provide snacks on our daily hikes instead of just annoying thorns to catch clothing and prick fingers and ankles.

That it's starting today is most likely imagined, simply because I want it to be. We have had snow well into March before, and I doubt that Winter will loosen its hold without a last bit of struggle. But the faith that it will soon come is real, and I'm ready.

Saturday, February 23, 2008

What's "fair?"

Daughter Juli and I had an interesting conversation a week ago, one that's been thrumming along in the back of my brain, perking up little thought-bubbles as I go through my daily chores. Then my brother and I spoke a few days later, touching on similar issues, which also folded into my internal dialogue.

Children, Juli says, have a warped world-view of consequences, brought on by the commonplace give-and-take of family dynamics. If they eat their vegetables, they get dessert. If they misbehave, their privileges are taken away. Within this context, they develop a sense that life is supposed to balance out, that there is a "fairness" to the universe; good deeds will be rewarded, bad deeds will be punished.

As we become adults, though, we learn that life is indeed "not fair" at all. Bad things happen to good people, even criminals go free, consequences weigh heavily on the poor and powerless, less so on the rich and powerful. The righteous seem to suffer, the sinners often get a pass. We try to make sense of seemingly senseless tragedies, and we struggle to reconcile and rationalize when we see miscreants bumble through untouched.

Some become cynics or curmudgeons when forced to recognize the unfairness of it all. Some, like Job, praise God for their misfortunes as well as their blessings. Some shrug it off as "just the way it is," and move through life with a positive belief in the eventual triumph of goodness, despite multiple misfortunes that seem to pile up inequitably on the debit side of the ledger.

The physical laws of nature favor entropy and chaos, not cohesion; yet we humans function as if everything is supposed to balance out, make sense, and be fair. For all of our faith in scientific method--observation, hypothesis, experimentation, & objective proofing--we reject the results of the overwhelming evidence of each of our lifelong tests.

We know life isn't fair, and yet we persist in our assertion that somehow it has to be. It's either a tribute to our resiliency, or the greatest delusion we have been able to devise in order to survive.

Friday, February 22, 2008

No Pain!

For the first time in more than almost four months I woke up yesterday without pain! It was such an odd feeling, it took me the better part of the morning to figure out what was different.

No pulling, aching, throbbing, burning or cramping underneath the right. I can move! I can breathe deeply! Wow!

The plastic surgeon said last month that I was at the "peak" of discomfort, just about 10-12 weeks after surgery, and that giving it a few more weeks might loosen things up and give me some relief. "Yeah, yeah..." I thought. Having lived in this state so long, I couldn't imagine what it would feel like to be without constant pain, and doubted that a couple more weeks might make it just magically disappear.

But here it is, with no warning or gradually lessening, just suddenly a second day of no discomfort. Maybe that stitch finally "popped" or dissolved, or did what it was supposed to do.

I'm thrilled and grateful. One more step toward moving on.

Thursday, February 21, 2008

Sharing a lunar eclipse

I had remembered that there was going to be a lunar eclipse and then forgot it again, when my daughter called unexpectedly last night.

"Quick, Mom," she said breathlessly, "go outside at look at the moon!"

I jumped up, phone in hand and went out on the deck. We both stood outside, looking up at the shadow of the earth creeping across a full moon, separated by thousands of miles, but sharing the same vision in the night sky.

I remembered the summer nights when she was small, glow-in-the-dark star charts in hand, picking out the constellations for her and telling stories about the birth and death of stars, the cold vacuum of space, the infinite distances in the universe. We'd snuggle under a blanket and talk about ancient times and ancient peoples, when humans watched the sky for their only entertainment, because they had no television or electric lights or books to read! Then we'd laugh and go inside for hot cocoa and bed when we were done looking and marvelling.

"I can still see a tiny glimmer on the edge," she said.

"It's completely covered, as far as I can tell," I replied, "but your eyes are younger than mine, so I'll trust your observation."

Maybe she was breathless because she was walking home from Trader Joe's with a bag of groceries, but I prefer to think that it was also an expression of long-ago, child-like wonder. Her impulsive phone call to share it with me was a surprising and precious gift.

Wednesday, February 20, 2008

Off to Yoder's

One of the very nicest things about living in this area is Yoder's Country Market. Run by Mennonites, Yoder's is a combination health-food store, country smokehouse outlet and the closest thing we have to a gourmet foodie-haven.

They cure country hams and bacon, and make the best butter I've ever tasted, rolled in 2 pound cylinders of parchment paper. They stock foods for special diets, odd cooking ingredients like Clear-Jel and walnut oil, dried fruits, nuts, baking chips and old-fashioned penny candies.

It's clean and friendly, with red-cheeked girls in white cloth caps cheerfully making sandwiches, and strong boys in suspenders packing groceries gently into sturdy boxes and carrying them out to your car. It's like walking backwards in time.

An outing to Yoder's is a treat I give myself about every other month. I usually have a long list of needed staples; today it's wild rice, wheat berries, rye berries, barley, flax seed, crystalized ginger, split peas, corn chips for my chili, pineapple jam and sweet pickles. I'll browse through the raw-milk cheeses, the bulk spices, the homemade baked and canned goods, and probably fill a whole basket with impulse items that catch my eye. It's both a splurge and a full morning's entertainment.

Tuesday, February 19, 2008

Tamoxifen Issues

I've been taking the tamoxifen, which has shown a 41% statistical improvement in preventing breast cancer recurrence, and I'm carefully monitoring my body for potential side effects, some of which can be profound: clots, stroke, endometrial or uterine cancer, and cataracts. The statistical benefits of taking it outweigh the statistical risks of the possible serious side effects, and my oncologist has recommended it, so I'm taking it.

I am careful to use the word "statistical," because no large-scale study can tell if tamoxifen will help me beat the cancer, or whether I will experience any of the problems associated with it. One encouraging bit of news came with the genomic testing, which showed that 2 of my 3 cytochrome P450 pathways used to metabolize the tamoxifen are functioning normally. I do have one "snip," a defect on 2C9, but 3A and 2D6 are fine. So the plan now is to take the drug, and be vigilant about any changes I experience.

I've noticed two new body-messages since starting the drug: I crave sweets constantly, (especially chocolate, of which I've never been fond, except in the week preceding my period), and the frequency of night sweats and daytime hot flashes is ramping up with a vengence.

I wake up each morning looking like I've spent the night in a sauna, hair damp and wild, pink limbs and blotchy face. I've also become very temperature-sensitive during the day, piling on layers one minute, then flinging them off in a panic as I perceive I am about to burst into spontaneous flames the next. I keep hoping that things will settle down and establish some pattern, but so far, whatever this estrogen-suppressor is doing, it's random and unpredictable.

The sweets thing is even harder--how do I follow the Prime Directive ("Don't gain weight!") and soothe the raging desire to consume every source of sugar in the house? I've tried eating an apple, letting one tiny, perfect chocolate chip melt in my mouth, and other intercessionary measures. I've resisted doing any baking at all, afraid that if I make a pan of brownies, I'll just wolf down the entire batch in one sitting. My days now are spent avoiding temptation, steeling myself against food, and downing big glasses of cold water as the sweat pours down my face.

Monday, February 18, 2008

Dark Matter and math confusion

Am I the last person on earth to find out about "dark matter?" I listened to a program about this recently (I hardly ever have the patience to actually sit and watch TV, but I do listen to it), and asked my son: "So do you understand the deal about dark matter?"

"Of course," he said. "What's the problem?" as if his mother was going suddenly dim. Apparently, all the space between matter in the universe is not empty, it's full of stuff (like the gunk the old Star Trek series called "anti-matter"). Scientists calculated how much actual matter was in the universe (by a mathematical process I missed, when I went to heat up a bowl of soup), and they came up way short, so they deduced that what they perceive as being empty space is actually invisible "dark matter." I'm still trying to comprehend this--is it like looking at a negative image or an optical illusion, where what you see is the stuff in-between the other stuff? They can't see dark matter, or prove that it exists, but mathematically, it has to be there. And don't even get me started on "dark energy," its evil twin. Concepts like this make me feel really inadequate, like my brain is stretching out as far as it can, and just isn't quite big enough to fold around the edges of an idea.

When I was 41, I went back to school because I was unhappy with my life and didn't want to take anti-depressants for it. I thought I wanted to go to Pharmacy school, so I started taking courses at the local community college, the pre-requisite math I couldn't pass in high school. Even though I never had made it through the second year of algebra or any trig at all, I signed up for pre-calculus, just to see what I could do. It was really hard. To get through just the first week of class, I had to re-learn what I hadn't used for 26 years, things like polynomials, quadratics and factoring equations. I did every nightly homework assignment twice. I attended every class, straining forward in my seat and listening with every fiber of my being, struggling to grasp the mystery.

In high school math classes, I had spent most of my time fuming about the dubious necessity of my knowing any of this "stupid stuff." At age 41, I knew that I was attempting to learn the foreign language of the universe, the absolute language of science. I was ignorant, but I had faith. Very occasionally, I would catch a brief glimpse of the immense world of mathematics. In a rare, breath-catching moment, the door would open, the light would shine through, the angels sang. I would sit very still, reaching out just a little further, brain cells curling like toes in sand, almost there...then a big, lunking, shadowy creature would barge into my brain, yelling "Hey! Who left this door open?" and kick it shut. Sigh.

But I persevered. I ended up with a B+ (which was a gift--I really only deserved a B- or a C+), mostly because the professor saw me right up front, everyday, trying so desperately. I gave it an all-out effort. It was a triumph of perspiration over inspiration. I moved on, changing my major to culinary arts, to everyone's relief, including my own.

I sort of "get" the dark matter thing, but I am also very comfortable letting the real mathematicians ponder it, just like I'm willing to let quadratic equations exist without me using them on a daily basis. I'm glad there are big mysteries in the universe, and I'm glad others are keeping tabs on them. I know if I work hard enough, repeat all the practice exercises, I might catch fleeting wisps of understanding, but that's as far as it will go with me. The big picture, as fascinating as it is, is something I want to be able to admire from a distance, like the immense beauty of the night sky.

Sunday, February 17, 2008

Looking for honest work...

I don't know whether it's the tamoxifen I'm taking or just a natural "let-down" of recovery, but I have noticed more disturbing tendencies toward boredom and depression this last week.

The only antidote I know is to get busy. Since I seem incapable of doing that here at home, I brushed up a resume and applied for a part-time job, two days a week in Kingsport, supervising drug screenings. We shall see if I have any marketable skills that the local economy wants.

In the meantime, there are plenty of projects that need doing around here--and I'm just not doing them. Daily, I manage to walk the dog and feed & bathe myself, but I'm having a hard time rousing myself to enthusiasm about anything else. This is my personal "danger sign," one that I've learned signals a warning to snap out of it and get going before I degenerate into total sloth, and by extension, despair and depression.

The whole week looks like it's going to be heavy on the gloom and precipitation. The weather really does affect my mood, so I'd better buck myself up before the rain and snow begin.

Saturday, February 16, 2008

Long-Distance Children

I miss my adult children. There's just no way around it, I wish I had them at the dinner table once a month, once a week, or better yet, every night, just to listen to what they did that day, what they think about everything.

The ultimate irony of parenting is that it seems interminable when you're going through it day-to-day, and it passes in what seems like a millisecond when viewed retrospectively. I berate myself for all the things I did wrong, and can't remember a single thing I did right, yet they turned out to be interesting and wonderful people. How did that happen?

I wanted them to grow into being smart and curious, caring and compassionate, responsible and independent. They did, and then they left, just as things were beginning to get interesting. I think it's terribly unfair.

Friday, February 15, 2008

Bad Night in Seattle

Daughter Juli was taken to the ER yesterday, and was admitted to the low-trauma ward of U-W's Harborview Hospital last night. It's been kind of frantic around here with the transcontinental phone calls and mother-worry, hence the late post today.

The good news is that she is now recovering--from severe dehydration brought on by nausea and inability to keep anything down, brought on by respiratory and ear infections. They may keep her another night, but she seems to have bounced back after they pumped 4+ litres of fluids and electrolytes into her. They are treating her for presumptive pneumonia, but the chest X-ray looks encouraging, with only minor problems and no TB.

I don't think there's anything that compares to the heart-clutch you feel when your child is really sick. Being far away and knowing she's an adult makes it worse...there really isn't anything I can do for her other than trust other people to take care of her. I hate it.

It gives me a renewed appreciation for what I just put my own mother through. Thanks, Mom, for just holding on, even though it made for many sleepless nights, I know.

Thursday, February 14, 2008

Valentine's Day Oddities, Earthquakes & Witch Trials

Today is Valentine's Day, and such occasions always bring up memories for me. It is my mother's 81st birthday. It is Aunt Mary's and Jim's 26th wedding anniversary. Valentine is my mother-in-law's maiden name. In his twenties, my grandfather looked like Rudolph Valentino. What else can I beat this dead horse with....?

Here's something odd for you numerologists: My mother was born on 2/14. I was born on 3/15. My daughter was born on 4/16. Three generations, exactly a month and a day apart! How's that for weird and coincidental?

I remember traveling up I-55 from Louisiana to Illinois for Mary & Jim's wedding in 1982. I drove my van, Bill rode shotgun, and his dad perched on the ice chest between us. As we drove north, the early greening of the southern spring disappeared, replaced by the vestiges of the Midwestern winter. Dirty snowbanks edged the highway, growing higher with each stop. We took a break near Cape Girardoux, at the site of the New Madrid (pronounced "Madd-Rid") earthquakes.

Reading the plaques that told the story of the quakes was a revelation. I had never heard of the New Madrid events from 1811-1812, with the largest-ever recorded earthquake in the contiguous states occurring there on February 7, 1812. It was so violent that it made the Mississippi River flow backwards, and permanently changed its location and course to what we know today. The people who lived there at the time must have thought it was a Biblical apocalypse. Sinkholes, geysers, giant rifts swallowing up barns and livestock, along with unearthly noises and violent ground shakes. Who wouldn't think the world was ending in fire and brimstone?

Being from California, I thought I knew earthquakes. I had become accustomed to "little shakers" so much in my childhood that I hardly noticed them, other than remarking that the draperies were swaying or the water in the fish tank was sloshing back and forth. I had also been through a "big one," waking at 6 am on February 9, 1971, thrown out of bed to the floor, and rolling back and forth across the room for a minute or so during the Sylmar quake, epicentered 120 miles away. But here was a giant zero in my geologic knowledge! Missouri isn't anywhere near the "Ring of Fire" I learned about in school. Here was the physical evidence of the biggest cataclysmic rocker ever, laid out before me, complete with visual aids and historical markers, nowhere near California! I was stunned.

The wedding was lovely, the reception was friendly and tasty (though a little heavy on the Jell-O salads as I recall--it's a Midwest thing), but my mind kept creeping back to the rest stop at New Madrid. Since then, I've seen the National Geographic and History Channel specials on the New Madrid fault and the 1811-12 quakes, and read first-person accounts, all breathtakingly horrific in detail and stunning in ignorance of what was really going on underneath the ground.

How humbling it is to discover you don't know everything you think you know. And how arrogant it is to look back at historical events and laugh at the misperceptions of the people who lived through them. Context is everything. Salem was infested with "witches" in 1692, their distorted visions now believed to have been caused by a psychedelic mold similar to LSD on the rye crop that overly-wet year. The scientific facts may change with historical distance, but perceptions drive the reality of behavior in the time the events occur. That can't be changed.

I seem to have digressed. Happy Valentine's Day to all, whatever memories it brings to you.

Wednesday, February 13, 2008

On hold with the IRS...Strauss & Mozart

The Internal Revenue Service is trying mightily to woo the public, if my morning phone call is offered as evidence. The recorded messages were not too annoying. The hold music selections were The Blue Danube and Eine Kleine Nachtmusik (and don't I just feel so smug that I know that)! Everyone who answered the phone stated their full name and employee number first, and spoke in tones usually reserved for members of the mental health professions. They...were...all...so...calm.

As usual, the fates gave me an agent with an Indian accent, so I had to keep asking her to slow down and repeat everything, and I eventually got the information I needed. I don't owe extra tax, but I do have to file two more obnoxious and confusing forms.

It's starting to snow and I'll be losing my internet connection soon, so it's back to wrestling with the taxes.

Tuesday, February 12, 2008

Deep in the Heart of Taxes

It's time to stop procrastinating and get started on the dreaded income tax. I tried out a couple of software programs online this morning and picked one that doesn't frustrate me too much, meaning it doesn't make me actually yell out loud while I'm actively using it.

It will be complicated this year, as I took early IRA distributions to pay for the breathtaking medical expenses. Both calculations will require finding and deciphering head-spinning instructions, and then there are the usual business income and expenses, and Bill's overseas ship incidentals. I know that I could avoid the flying piles of paper and adding machine punching if I did all of this bookkeeping monthly, but I decided a few years back that I really would rather just do it in one all-out annual effort. Why should I get all fatoushed every month, when I could postpone it into just one giant two-week aggravation in February or March?

I'm one of those nuts that supports the Fair Tax (knowing of course, that it will never happen--I'm not that crazy). It's a national sales tax, and has the added benefit of abolishing payroll taxes, corporate income taxes, the IRS and the entire bureaucracy surrounding it. It taxes consumption, not production, which seems like a much better idea to me. It even encourages recycling and reselling, as goods are only taxed once, when they are new. Heck, I'd even go for a Flat Tax, if it just did away with all the paperwork. I realize there are problems with all systems of taxation, and though every politician promises "change," it only gets worse with a new crop of incremental tweeks each year. Around this time of year, I become a cranky anarchist, thinking that the only way to fix things like taxes (or education, or social security, or medical insurance, for that matter), is to abolish the whole system and start all over again.

When I was working for my accountant, there was a reproduction on the wall of the very first income tax form. On line 1, you wrote down your gross income. On line 2, you calculated 1% and sent it in (if you made more than $100,000 your tax was 2%). I'm sure in 1919, it must have seemed simple and innocuous, and not at all like the beastly monster it has become. Sometimes I think I would pay them whatever they wanted if they just sent me a bill instead of making me fill out all these blasted forms.

Monday, February 11, 2008

Biochem for Dummies

Looking over my genomics profiles, I wish I had paid more attention in Biology 1, 2, and 3, thirty years ago. Even if I had, would I remember any of it? Probably not. I've been re-introducing myself to the basics of biochemistry this weekend, with a little success.

At least I now have the ability to decode most of the information into plain English, and then confirm it with secondary and tertiary sources on the Internet. It is fascinating, if somewhat disconcerting, to read about the damage I've done to my body in the course of living almost 55 years. Considering how much "fun" I've had in that context, I'm actually in pretty good shape.

These "snips" (single nucleotide polymorphisms), are not inherited--they are identified mutations of the gene mitosis codes, theoretically due to exposure to pollution, pesticides, solvents, drugs, carcinogenic substances, heavy metals, toxins (biological and chemical), and free radicals circulating in the body. Then there are the enzymes that detoxify all the bad substances in the body, and how efficiently they are working. I now have a pretty accurate picture of what went wrong and what might have triggered my cancer, and what is going on now with my heart, bones, hormones, liver, and gut. Whether or not interventions can be made to slow any problems or even improve my overall health is still supposition, but I'm willing to give it a try.

The good news is that whatever the effects are of improved nutrition, dietary supplements, exercise and other lifestyle factors, they can be objectively monitored and measured via traditional scientific methods. The prior genetic damage can't be undone, but perhaps further damage on other pairs can be avoided. The enzymatic efficiency can be quantified to see if it's getting better or worse. Levels of "good" estrogen and "bad" estrogen can be compared to this baseline measurement in six months to see if they are getting better or worse.

This approach pleases me. It gives me the feeling of doing something positive towards improving my own health (other than just vague imprecations to "eat more fish and vegetables"), and it can be objectively verified to be working or not by real data. I can keep my inate skepticism at bay with a program like this, at least until I see the results.

********

For those who have asked: GENESIS is an acronym for Genes, Environment, Nutrition, Exercise, Stress, Inflammation/Immunity, & Spirituality. See? That's pretty benign, not quite a "Dr. Evil" scenario is it?

Sunday, February 10, 2008

Long-distance marriage

We're almost midway through Bill's tour of duty. This is usually the point where I have adjusted to him being gone, where I am fully into the swing of activities that define my "woman alone" life, as opposed to my "wifely" life. I eat whatever I want and whenever I feel like it. I sleep on my own schedule. I do what I please, go where I want, run my own life without consultation with or consideration of another. Yes, it's really all about me right now, but I'm not entirely comfortable with it this time.

For many years when the kids were growing up, his schedule was 10 weeks home and 10 weeks away working. It would take about 3 weeks for everyone to settle down into the new routine when he left, and about 3 weeks more to adjust when he came home. Sometimes it was really hard. We worried about how it affected the kids, if they felt abandoned, or how I was by necessity always relegated to the status of disciplinarian parent, while Bill always got to be the indulgent dad, coming home with presents and no ongoing issues. We rationalized it by thinking that most dads only get to see their children for a few hours at night before bedtime, while Bill got to be a full-time dad on his 2 1/2 month vacations. In the end though, we weren't going to change our weird lifestyle. It was just what we did and how we lived.

I'm sure some people in our insular rural community suspected that the very existence of Bill was a myth, a pretend story to cover up some unimaginable tale of immorality or depravity. There were hints of that kind of gossip, that insidious fuel of small-town life. If anything, the kids were mortified at times that we were a committed couple, still married to each other, as if that made them objects of curiosity and derision in a population where multiple divorces and unmarried parenting was unfortunately all too common. I was dismayed about the local culture, seeing betrayed wives excoriating faithless husbands and their new floozy girlfriends in the local paper, and large families of siblings, each with a different father.

"Why can't you two just be normal?" I remember teenaged Juli wailing. "Why can't I just go live with my father on the weekends?"

Somehow we worked it out, I don't remember how. Some years I thought I simply couldn't do it anymore, that in order for our marriage to survive, Bill would have to find some other way of making a living, I would have to give up being a stay-at-home mom with part-time jobs and we would become a struggling two-career household instead. Other years, we just lived in 10-week chunks without thinking about it. Then sometime in the late 1990s, I just decided to stop mourning the loss of a "normal" life and embrace the opportunity that gave me a chance to live two different lives simultaneously.

About that time, I became the object of envy in my circle of friends. "I wish my husband would go away for 3 months so I could learn to like him again," one woman confided. "After 25 years, he's getting on my nerves!"

It's true. If we had to be around each other continually, we probably would get fed up with each other's idiosyncracies. He gets impatient and stubborn. I get obsessive and have an extremely short attention-span. Luckily, I am also blessed with a selective short memory and general optimism, so every time he comes home, we get to begin again. It doesn't matter what arguments we had before he left, because I've already forgotten them. The excitement of the reunion and the strangeness of being around each other again after a long absence means we get to redefine the parameters of our interactions. There are many years of shared memories, but plenty of new information to share for the first time. It keeps me interested, because we've changed and yet, the bedrock of respect for and loyalty to each other in the relationship is still the same.

Of course, it's different now too, without the company of our kids to keep me interested and engaged. It is lonely at times, and I miss the dynamic of the family life, even with the inevitable drama and emotional uproar of all those personalities trying to coexist. But mostly, I miss my partner, for all his qualities and faults. We may be halfway through his absence, but I haven't found my rhythm yet, and I'm still fussing and fighting it.

Saturday, February 9, 2008

Dogs as Reckless Teenagers

Sometimes I think my dog is a furry, retarded child. Dogs don't plan ahead, see danger or assess the consequences of their mindless, instinctual actions. Dogs just do whatever pops into their walnut-sized brains at the time.

Yesterday Echo and I were exploring up behind the house on our daily perambulation, and I decided to go up a trail I hadn't been on before. She bounded ahead, while I picked my way through the deep leaves and fallen trees on the seldom-traveled path. It got steeper and narrower as we climbed, and finally the path just got too difficult to continue, so I turned around and started down again. Echo, however, caught a scent and continued up the hillside above me, and when she was done sniffing, she decided to come straight down the steep slope to meet me.

I could see exactly what was about to happen--there was a sheer drop behind me, she would get going too fast on her four legs and start to slide, and inevitably shoot past me out of control and over the cliff! I lay down across the trail on my stomach, wrapped my legs around a tree, all the while talking to her in a calm voice "slow down, slow down," and as she shot towards me, I grabbed her collar, blocked her chest with my arm, spun her around and whumped her down beside me. I held her firmly around the neck while her dangling hind end scrambled back up onto the path.

Whew! The split second that had turned into a slow-motion movie resumed normal time. It worked perfectly, just as I had planned, and it was only afterwards that I realized I had only that one chance, and it could have gone much differently and ended badly. While I thought about that, I scolded her, and she leaped to her feet and wagged her tail triumphantly.

Now you're going to scold me, aren't you? But somehow, I knew exactly what to do without thinking about it, without having any time to think about it. I lowered my center of gravity, hugged the ground and secured myself first--there was never any chance that I was going to go over the precipice with her. I made the catch and it worked! Hooray for me! Is this what wide receivers experience in the Super Bowl? It was downright exhilarating.

But I don't think I'll take that particular path again, and certainly not with Echo. When I told Bill about it on the phone this morning, he knew exactly which place I was talking about--he sometimes sits out there waiting for deer to appear.

"Makes you wonder what she does when she's out by herself," he sighed. "I wonder if she'll ever grow up," sounding just like any father of a teenager.

Friday, February 8, 2008

Yoga & Bad Dreams

I actually hauled my sorry bod out to yoga class last night. My balance is terrible, I still wobble like a drunken, one-legged shore bird and I can't do what everyone else in the class seems to do with ease. But it wasn't really bad, in fact at times it felt good to just stretch. I was able to have a range of movement that is much improved from the last time I went to class. And I was able to support myself on my arms for the first time.

Once again though, the mental part escapes me. It's so very boring. I know, I know...I'm supposed to be concentrating on my breathing and quieting my mind. But the insipid music leads to wool-gathering leads to making lists of things that need to be done, leads to whatever needs to be worried about or figured out. I shake myself back into the zone, only to find a minute later I'm whirring around in my head again like a mindless hamster on an ever-spinning wheel. It's as bad as factory work for keeping the mind occupied.

Then for some reason I woke up at 2 am in a bad sweat, with pounding heart and one of those "chasing" dreams. This time I was chasing Alex, who was chasing Echo, though I was doing a bad job of it, with one shoe on and one shoe off, alternately loping and hopping madly through a parking lot in the rain, trying to get to a giant tour bus driven by my cousin, Francie. So what the heck is that all about? After an hour of tossing about, phoning my kids (it was 11 pm on the west coast, why not?) and thinking about getting up, I just gave up and got up.

I'll probably have to nap this afternoon to make up for it, but it was better than just lying there being as bored in bed as I am at yoga.

Thursday, February 7, 2008

Spitting in tubes and resulting conundrums...

For the past month, I've been waking up, rinsing my mouth and spitting 3 ml. of saliva into test tubes for estrogen levels testing. Today, I collected the last sample, and am waiting for DHL to come and pick up my frozen spit for transport to the lab.

My first results from the genomic tests taken in January were emailed to me yesterday. It's going to take me awhile to digest this 56-page report (with even more accompanying detailed attachments), and the biochemist who has coordinated all of this testing will be calling me tomorrow morning to help explain what it all means.

I have not mentioned this before, because it all sounds so strange to me. It's either incredibly exciting or terribly embarrassing to be part of this project called GENESIS, suggested by my insurance provider back in December. Genomic testing could be either the cutting-edge future or the stupid nonsense of alternative-medicine pseudoscience. I have been highly skeptical through the whole process, monumentally nonplussed, waiting to see what the results are before committing myself to a plan of action that either embraces this newest "technology," or propels me screaming back into the arms of traditional medicine.

There are problems with both approaches. I have discovered that the practice of medicine, and specifically the business of cancer, is based on large-scale, statistical studies of groups of patients. Survival rates, treatment protocols and oncologists' recommendations are all predicated on the supposition that an individual cancer victim can play the percentages like a gambler in Vegas and have a probability of beating the reaper, at least for the first five years.

But then there's this genetic marker thing out there too, slowly gaining acceptance in the traditional medical environment, as seen in the new Oncotype DX test that my oncologist ordered that statistically predicted that I was at low-risk for recurrence.

GENESIS takes it even a couple of steps further, by mapping specific genes and identifying SNPs (pronounced "snips," which stands for "single nucleotide polymorphisms)." Those SNPs are variations in the genetic code that occur only at certain places on your chromosomes, and everyone has them--it's what makes us different from each other. Some SNPs have no effect on our health, but others can predispose us to disease or influence our response to a specific food or drug. Or so goes the argument.

It certainly sounds reasonable, but on the other hand, it also sounds like B.S. to someone accustomed to traditional scientific methodology. The objective truth is most likely somewhere in the grey area between so-called personalized treatment and statistical group probabilities. No one really knows where genetic research will lead. Will this infancy of genomic predictive factors become the standard norm in coming years as more is discovered and confirmed, or be discarded on the heap of plausible ideas that just didn't prove out?

By agreeing to be part of this project and having the initial testing done, I have willingly put myself in the position of having to eventually choose between an unproven new idea and a flawed-but-accepted treatment regimen. Either path could either extend my life or kill me anyway. I recognized that this was the danger when I first decided to be part of it.

I kept thinking throughout the process that I wouldn't be forced to choose, that I could walk between the new and the old and find a happy medium that would maximize the best aspects of both approaches. But now, looking at my test results at first glance, I realize that it was inevitable that I would eventually have to make a decision that comes down to literally betting my own life.

I'll continue to gather more information as the process unfolds. But I am no longer confident that I can play the odds at the same time I am exploring supposedly new frontiers. I'm going to have to decide what I believe and what I will do to take responsibility for my own future health. And back up that belief and responsibility with my own life on the line.

But what other choice would I have made? The person I am demanded that I at least question the status quo, and challenge the accepted, normal path. The optimist in me, the rebel in me, the faith-in-the-future me made it impossible to turn away from a possible opportunity that the new way might be a better way.

It's almost worthy of a classic tale of character flaws and hubris (or more realistically, a sappy mini-series about good intentions gone bad). I have a small amount of time in which to decide, and in the end, only the passage of more time will determine if I chose well or poorly.

Wednesday, February 6, 2008

Tornado in Tennessee, but not here

When we first moved to TN about 2 years ago, my mom would call whenever bad weather was in the news. To forestall any worry out there, we are fine this morning in the northeast corner of the state. It looks like those poor people out in western TN have a massive cleanup ahead of them though. The city of Jackson, between Memphis and Nashville, was hit very hard.

It does feel like "tornado weather" here -- unseasonably warm, very humid and low pressure on the barometer. Yesterday on my daily dog walk, I became so overheated I had to leave my hat, gloves and jacket on the trail to be picked up on my way back home. The thermometer said 70 at noon, and that was a new record high for early February in this area.

We don't have enough flat land around here for a tornado to really get going and pick up speed. Too many geographical features break up the formation of twisters, and we have the hills and mountain ridges here. If anything, we are more likely to have an earthquake here than a tornado. (I recently found out that this silly round house is built on a flexing earthquake "pad," as the man who built it was from California).

So, no worries here, just an unusual tropical heat wave.

Tuesday, February 5, 2008

Someone who agrees with me!

Finally, an explanation that makes sense!

The Kingsport plastic surgeon thinks the pain I am experiencing on the right side is a suture that either didn't dissolve, or was poorly placed where it pulls on the muscle whenever there is movement. He explained that these stitches are put in there to tack the alloderm (a mesh-like matrix to support the implant) to the chest wall muscle. My implants are actually under the muscles, in a "pocket" formed with the alloderm, not riding on top of the muscle as I had thought.

He was just as unhappy with the cosmetic results as I am (as opposed to UVA, who said "Well, most women would be happy with your result!)" Then he surprised me: "If I were you, if I were a woman, I'd be really upset with the way it looks here!" he sighed, referring to my cleavage. He thinks they didn't place the implant far enough to the center on the left, causing the "pooching out," and they sutured it too tight on the right, causing the "puckering in" there. He says this can be easily fixed. (UVA said the right could be fixed, but said nothing about the extra flappiness on the left).

Although he seemed hesitant in "taking over" someone else's project, I told him that while I was happy that I had the reconstruction done at the time of the mastectomy, I really would rather have any "corrections" and the nipple reconstruction done locally, so that if there were problems and follow-up visits, I wouldn't have to travel 600 miles each time. Also, I was not comfortable with the attitude that I should be grateful that I look good in clothes (never mind how I look naked to myself), and was getting frustrated with the large-scale clinic atmosphere up there. The fact that I never see the same people when I go means I have to explain everything over and over again each time.

This doc took the time to explain things to me, agreed that it doesn't look good, and he can fix it so it looks pretty. "After what you've been through, you deserve for it to look good, not just okay," he said. I agree.

We decided to give it another month to let muscles loosen up and relax a bit. I can start to work out with weights now, (he assured me I won't damage anything), and if I'm still in pain then and want him to find that annoying stitch, loosen the encapsulated stiffness around the implants and fix the cleavage, we'll schedule an outpatient surgery then. Recovery would be about 2-3 days.

I also asked him about "what happens in 10-15 years when these implants fail? Am I going to have to go through all this again?" He said no, the hard part was over, it was just a matter of changing out the implants, like putting on a new set of tires. It's an analogy I can live with. I think I've found my guy.

***

For Judy in Texas: (and all others who wonder "Whatever happened to poor old Bill?)"

Bill is doing just fine, tooling around the ocean and exotic Oriental ports-of-call. He is almost half-done with his four-month tour of duty on his somewhat secret ship on their very secret mission. We email each other daily, and he calls whenever he is in port. By the time he gets home in mid-April, my "honey-do" list for him will probably run three pages!

Monday, February 4, 2008

Getting used to it?

While I'm not there yet, I can anticipate a time when this really will all be behind me. I am getting glimpses of a feeling of permanent change that maybe, someday, won't be so profound. The sheer shock of seeing myself in a mirror hasn't worn off yet, but the whole-ness of my body is starting to become real again in my head.

It's still weird, don't get me wrong. When I lie on my back my "breasts" point at the ceiling instead of falling into my armpits. I still feel like a Barbie doll in dress-up clothes (though, with a added middle-aged abdomen, unfortunately) when I think about it, but I am starting to think about it less. I am just a little less self-conscious in public, without constantly thinking that everyone can tell that I've been re-built. If it weren't for the fact that I anticipate and experience pain with each movement, there might be whole hours that don't involve self-absorbed rumination about how life will be from now on, what I am or am not capable of doing.

I guess what saying is that I don't feel so damaged, so mutilated anymore. I'm getting comfortable enough these days to stop dwelling on it, every minute of every day. I'm slowly assembling a new picture of myself, as I am now. I am starting to forget what was and how it used to be, and the comparisons are fading because I no longer trust my memory of the old body image. This is the vessel that is here and now, and it is starting to overtake what was.

This must be progress, yes?

Sunday, February 3, 2008

Daily walking

Today, Echo and I climbed up to the western ridge of the property. Everytime I go up there, I want to build a house up on top of that hill. As I bushwack through the brambles, I'm searching for a way to build a road, looking at the steepness of my climb, trying to figure out how we would ever carve out a driveway that was navigable or practical. A drilled well and the septic system would probably cost as much as a house, and the cost of grading a road up that hillside would probably exceed both.

Coming down the path this morning though, for the first time I considered siting a house tucked into the hillside itself, overlooking the back of the pond. Having walked all over this up and down property of ours (except for the places where I'd need climbing gear, ropes and a belay), I realize that there is a reason people choose to live in the "hollers." Up on the ridges, I can hear the noise of the highway, three miles away. Snuggled in the notches, it's markedly quieter. Maybe a house could be built halfway up the ridge, to take advantage of the quiet and the view?

Winter is coming to an end, I can breathe it in. The woodpeckers are out making a racket in the trees, tiny bits of green are poking out of the dead leaves at my feet, getting ready to explode into renewed growth. Along the road the past two days, new baby calves are appearing, peeking out from under their mothers udders, staring curiously at the strange creatures striding by, woman and dog.

It is supposed to get warmer and rain this week, which will put a damper on our long daily walks. Tomorrow's routine will have to be short and early in any case--I have an eye exam and finally a consult with the plastic surgeon who can hopefully tell me why I am still in constant pain. If there is no reasonable explanation or quick fix, I think I will ask for a referral for physical therapy, to see if that might give me some relief.

I'm glad I have the excuse of the dog to walk each day. It's undoubtedly good for my body and spirit to be huffing and puffing up these hills in the clean mountain air, and it's a daily "chore" that gives discipline and structure to each day. If I didn't have Echo "nagging" me every morning, I might not drag myself out there to see and feel the changes each day. As it is, once I get moving, I'm glad to be outside, senses aware and alive.

Saturday, February 2, 2008

Where did that 10 pounds come from???

The last thing my surgeon said to me at my exit appointment in November was "Don't gain weight!" Not only is obesity a risk factor for breast cancer, but gaining weight after having breast cancer increases the chance of recurrence by some exponential percentage. No problem, I thought. I've got this down. I lost 30 pounds last spring, I am a fat-burning machine, I exercise daily. I can go and sin no more.

Today, 3 months after my mastectomy, all of a sudden there's an extra 10 pounds on my scale. I'm walking 1-2 miles a day, doing my stretching exercises, eating small portions. What happened here? My metabolism has ground down to a crawl, I'm craving sweets and starting to pack on the pounds again. I've developed those floppy "wing things" under my arms (how attractive, and just in time for those summer fashions)! I keep thinking if I could work out with my weights I could get this under control again.

Whatever it is, it's annoying and it can't be allowed to continue. I'm making a big pot of skinny chili today and going into Zen-mode again. Don't tempt me with your Super Bowl snacks, your Valentine's Day bon-bons, your Easter jelly beans.

I am a fat-burning machine...I am a fat-burning machine...

Friday, February 1, 2008

An "L" Day

It's a laundry, library, lawyers, and "life is good" day.

The laundry will be able to be done at home, for the first time in many months. Our well now has sufficient water, thanks to the rain we've gotten, and the septic drain is clear, thanks to the emergency excavation and unclogging in December. No more trips to the laundromat!

The library trip will signify that I am ready to commit to a regular schedule of visits again, ready to assume an obligation, a two-week chunk of reading that has to be returned on time.

I woke up this morning thinking I need a different lawyer. The one I spoke to in September is dismal at returning my calls, I still don't know if that firm will actually take on my litigation, and it's time to either get going on this or find another attorney to represent my case.

"Life is good" is just that. I'm feeling the fog of ennui lifting, I'm getting a little more motivated. Today is the first day of a new month, which means administering dog meds, furnace & septic maintenance, checking the house systems and other regular homeowner chores.

Moving forward again...