Autumn Sunrise

Arising early yields an unexpected reward:

It is good to greet a day that begins this way.

BioChem 101

I had a long phone consult with Dr. Veltmann, the biochemist, in New Mexico yesterday. The results of my UEM test are in, and he spent about an hour explaining everything to me. My brain was seriously taxed, but I want to be well-versed before I see my oncologist, Dr. DaSilva, on November 11.

The bottom line (for those who have no desire for the long science story) is that my estrogen profile looks really, really good. All those pills (25 per day--GULP), have had the desired result. Estrogens are like cholesterol numbers--there are good guys and bad guys. My "bad" estrogens are being converted to the "good" protective estrogens at a more efficient rate. By comparing my test results of 2 years ago, when my bad guys were off the chart and my good guys were low and struggling to keep up, we can see that the Sam-E, DIM-PRO, and B-vitamins are facilitating the metabolism of bad to good. Almost all of my good estrogens are now at high levels and my bad ones at low levels.

Since my cancers were ER-positive, fueled by the bad estrogens, this is presumptively great news.

So here's how it works: The body produces Glucocorticoids, which are converted to Androgens.
The primary ones we are concerned with are DHEA which is converted from 17-OH-Pregnenolone to Androstenedione, and the Androstenedione that is converted directly from 17-OH-Progesterone. This is then converted to Estrone (E1) by the enzyme Aromatase.

The oncologist is talking about putting me on an Aromatase Inhibitor, which will disrupt this conversion, effectively wiping out all estrogen production in the body--the good guys along with the bad guys.

But that's not the whole story of estrogen. Estrone (E1) is converted back and forth to Estradiol (E2), (meaning that if the body has an excess of one, it converts some to the other, to keep the two in balance). But E1 also converts in a one-way direction to three other compounds, using the liver's Cytochrome p450 pathways. Two of these three E1 metabolites by themselves are bad guys, 16-alpha-OHE1 and 4-OHE1. The other, 2-OHE1, is a powerful anti-cancer protectant. But the two bad guys can also be converted to good guys: 16-alpha can be transformed to Estriol (E3) and 4-OHE can be changed to 4-MeOE1, if you don't have a mutation on the COMT gene. I have this mutation, a SNIP (single-nucleotide polymorphism) on the COMT and another one on the CYP 1B1 pathway from E1 to 4-OHE1 (which gets converted to the good 4-MeOE1). These mutations are probably what caused or contributed to my estrogens going crazy and fueling my cancers.

According to this latest test, I am close to where I need to be, except for production of E3 from 16-alpha. I have a little too much of bad 16-alpha, and a low level of good E3. The idea that my oncologist understands this biochemistry and will prescribe Estriol to a cancer patient is, shall we say, not bloody likely. So, Dr. Veltmann and I have decided to up my dose of Sam-E, to assist the COMT conversion pathway instead.

The bigger issue is the Aromatase Inhibitor that Dr. DaSilva has mentioned he wants to switch me to. This shuts off the conversion of Androstenedione to Estrone (E1), effectively robbing the body of all the good guys while shutting off all the bad guys. It also leads to a complete and dramatic menopause, more effectively than surgically removing the ovaries. This drug blocks all estrogen production, from all over the body--from fat cells, adrenal glands, etc. After superficially understanding the complicated biochemistry of this system, I fear this drug.

First, I find this explanation of good estrogens versus bad estrogens extremely plausible, given what we know about the delicate balance between LDL/HDL/Triglycerides in regulating cholesterol in the body. Hormonal systems are extremely complex, and I'm pretty sure being in balance is more important than just turning off the estrogen spigot.

Second, I am wimpishly afraid of even more dramatic menopausal symptoms. I'm barely tolerating the truly awful hot flashes, the loss of short-term memory, the insomnia, the night sweats, due to the tamoxifen now. Tamoxifen works in a different way--it sits on the estrogen receptor site of every cell in the body and blocks the entrance gate, but it doesn't interfere with the production or metabolism of estrogens throughout the body.

We are still awaiting the results of the full-month cycle spit test, but the results will be in before my appointment with Dr. DaSilva. Hopefully, I will be able to digest all this information enough to talk to him coherently, and convince him that I'd be better off staying on the tamoxifen.

The Dogless Life

It's very weird. Each time I walk into another room, I keep expecting to see Echo--bounding off the couch, ears up, tail wagging, ready for a walk outside. When I am upstairs working on the computer, I have half an ear out, listening for her padding up the stairs to the loft. When I've been involved in a project, I suddenly think, "did I let the dog in?"

We're very sad, but coping for the most part. We tell funny stories about her, and laugh through our sudden tears when one of us says, "do you remember when she...?" All normal processes, but it's hard to get used to being without her constant presence. So much of our daily structure revolved around her needs, and we are suddenly rudderless.

Bill is coping by cruising dog-adoption websites, prefacing each "listen to this!" with a disclaimer of "I know we're not ready for this now, but..." He has decided that Echo was indeed a Belgian Malenois, after doing research on their behaviors and putting to rest the issue of her black-spotted tongue--it turns out that lots of breeds have this characteristic, and it does not denote any Chow-chow heritage by itself. He has stopped calling Echo the "Faux Malenois."

I am just taking it one day at a time, trying to desensitize myself to the jolts of remembrance and the eerie absence of my furry friend. I'm waiting for time to do its magic, and the images of her death to be replaced by mental pictures of her alive and active.

Sigh.

Independence Day...of a sort

In anticipation of having the carpets cleaned on Wednesday, I started cleaning up the floor clutter this morning. I was booking right along, swamping out the canning jar collection, the piles of "to be filed," the heaps of clothes "to be mended," the books that never got home to the bookshelves, when I happened upon a great big compilation of what I like to call "My Breast Cancer Homework."

This was my life, for two whole years. Notebooks full of hospital-provided info, pamphlets on clinical trials, tumor classification flow charts, worksheets on radiation and chemotherapy side effects and remedies, articles ripped out of magazines, medical abstracts printed off the internet. In one giant leap of faith, I heaved the whole hearty mess of it into the trash.

The niggling voice of "what if you need it again?" was drowned out by the pragmatic realization that if I get cancer again, all of this past information will be either uselessly outdated or cheerfully thrust at me again. In a big binder with a pink ribbon on it, thanks so much.

For the moment, it felt great to throw it all out. Liberating, in fact. Nope. Don't need this anymore. Done.

And then tonight, I came across this gem: Rethinking the War on Cancer http://www.newsweek.com/id/157548/page/1

Seems as though 37 years of research hasn't done much except cure cancer in lab rats, mostly because the funding is going to "scientifically elegant" studies that tickle the NCI's curiosity, without showing much in terms of actual human patient benefits.

I certainly can't complain of the advances that I personally benefitted from. But it appears that this dovetails into the ACS's statement earlier this week that the scientists aren't really sure why cancer diagnoses are proliferating at a spectacularly alarming rate, and survival rates aren't increasing proportionally with the increases in early detection. This article explains some of that, and gives a window on why the research is striking out on preventing metastises, which is what kills most cancer patients. And focusing on treatment isn't working out that well, after all.

I have been supremely blessed in my treatment options, and for the moment, all's well. But these rogue cells are sneeky little buzzards. They mutate (that's what started the problem in the first place), and they adapt. For every treatment thrown at them, they seem to find a way around it. And so far, the scientific approaches haven't begun to understand the mechanisms of why good cells go bad.

The one sure thing that cancer taught me was that we all have an undetermined expiration date. This was of course true before I had cancer--it just took that experience to make me believe it. I am more determined than ever to enjoy and treasure the life I have, and make every moment count. We don't get to choose what happens to us. We only get to choose how to live with it.

Better Today

I woke up feeling sad, but not overwhelmed like yesterday. Today, there is just normal grieving going on, not the shock and guilt we felt when Loki died suddenly one morning, 10 years ago. Maybe it's the awesome healing power of rationalization, but I know we did all we could for Echo, ultimately couldn't save her from her inevitable demise, and gave her mercy and peace at her end. I'm okay with that.

Bill is having the harder time of it I think, because he wasn't able to be here for the closing chapter of the story. Though he left Monday knowing that he probably wouldn't see his dog again, it was hard coming home to a suddenly dogless house. But we're both dealing with it, and we will heal with time.

In the words of Forrest Gump: "That's all I have to say about that."

Echo Laid to Rest - Epitaph for a Good Dog

It is a glorious autumn day. Cool breezes are shaking a floaty, colorful rainfall of leaves onto the forest floor, the warm sun is shining, and the birds are calling. I just came up from the pond--where Bill had prepared Echo's final resting place, and I just finished burying her.

Echo went to sleep for the last time at 9:30 this morning, in the back of the red car where she was always so happy. She was lying on her "double-stack" dog bed, with her chin resting on her favorite toy, Hedgehog. There was no pain, and the vet and I sent her off with our mutual tears and gentle words, both of us stroking her soft, furry ears for the last time.

I know I will spend the next few days, weeks, maybe months, automatically looking for her in the house, thinking "I have to take the dog out," or "is it time to feed the dog?" These animal companions of ours become such an integral part of our daily lives. They worm their way into our hearts, and it is so hard to let go. But what I did this morning was a loving mercy, a refusal to let my friend suffer any longer.

As long as there was a chance she could be treated (or would quietly expire on her own), I kept the faith with her. But yesterday, the Leptospirosis test finally came back, and it was negative. The only good news in this is that Bill and I won't have to be on doxycycline for the next month ourselves, since it transmits easily to humans. So, after ruling out the lepto, we were left with the obvious signs of a massive and ultimately fatal abdominal tumor.

The vet said she was a fighter--any other dog would have been dead three weeks ago. Even if we had taken her to UT and spent thousands on further treatments, the vet said the outcome would have been the same. Bill and I concurred.

She stopped eating anything at all on Monday, and as she grew progressively thinner over this week, I could see how the tumor was taking over her body. I just couldn't bear to put her through any more drastic measures; Bill, still in Philadelphia, said not to wait.

So, I did what I could for my canine friend. My dog Echo protected me on the property from other dogs and human strangers and was a whiz at catching and eating any stinging insect that made its way into the house. Her insistence on exploring the woods every day got me outside and on the road to physical and mental recovery from my surgeries last year. She was a constant source of amusement and laughter with her doggie antics. She traveled all over the country with me, logged more than 30,000 miles, left her "mark" in hundreds of highway rest stops, and invariably took the best bed in every Motel 6 we stayed at.

While she was a fine "townie" when we lived in New York, she came into her own when we moved to Tennessee. At last she had acres to run in, critters to chase and watch (she especially liked making turkeys fly), and she mellowed into a total country dog here. She loved digging for chipmunks and squirrels. She even got over her fear of water, happily trotting through the creeks, especially if there were frogs and fish to stalk.

We noted, however, that she still loved sleeping on the couch when the sun went down.

She was a great companion, and a faithful friend. Rest in Peace, Echo. We loved you greatly, and you returned our full-hearted devotion with your own.

"The dog is the most faithful of animals and would be much esteemed were it not so common. Our Lord God has made His greatest gift the commonest. " -- Martin Luther

It's That (Pink) Month Again

Thank you, I'm so aware of Breast Cancer Awareness Month.

In Walmart yesterday, I experienced my annual annoyance at pink-themed merchandise--including the extra bonus this year of pink-packaged Halloween candy for the kiddies. The mind boggles. Never to early to let them know that the world is dangerous and cancer could strike at any moment. And be sure to go home and tell Mommy (and Daddy too!) to go get a mammogram!

Oh, wait. This is on the heels of the ACS waffle-fest yesterday about how mammograms really might not be that great as a screening tool because you could get an aggressive tumor the day after you have your negative mammogram result.

What? After a generation of being told that "early diagnosis saves lives," now we are being told by the scientists that it ain't so.

Seems that while breast cancer diagnoses are through the roof, not all of the tumors found are of "the type that will kill you," (at least not right away?) and the ones that will kill quickly aren't being diagnosed fast enough to save you. And the survival rates aren't improving, despite all the added screenings and surgeries.

Are women being thrown under the bus here? Is this just a precursor to the coming nightmare of supposed "universal" health care (which isn't really health care, it's just super-regulating our health insurance, which is not the same thing at all).

So they start the debunking process of the only relatively cheap, wide-range screening tool we have, working to destroy the confidence in the efficacy of the mammogram, leading to lowering the number of women being screened (which isn't all that high to begin with, despite all the Pink Snickers bars!), which will fit right in with the government's future inevitability of rationing care based on the cost versus the value of a middle-aged woman's life to society at large.

Grumble, grumble.

In Great Britain (that model of efficiency that Congress points to as an example of what we should have here), women over the age of 50 who have the same Stage I-C breast cancer I had are being sent home without treatment and told to get their affairs in order. In other words, "You're not worth saving."

I thought my initial diagnosis meant certain death, but after being educated for the last 2 years in an up-close-and-personal way, I am now looking forward to being an old lady someday.

There's something really insane about flogging people to "be aware," while telling them quietly that it may not matter anyway, because the test isn't all that great after all. And, by the way, we're getting you prepared for when we tell you that you aren't worth treating.

And, I am NOT handing out pink candy to children, that's a grumpy "Roger" for sure.

Rethinking "Ugly"

Thanks to MaryAnn and Hannah having a little side-comment fest going about my new Crocs, I've decided to re-evaluate my initial aesthetic judgment. My new mantra is: "A Comfortable Pair of Shoes is a Beautiful Pair of Shoes!"

I spent some of yesterday looking on eBay at Crocs and decided that there are some v-e-r-y clever knockoffs coming out of Hong Kong right now (mine are Made in the U.S.A.). I looked at other colors, and frankly my dear, none of them rocked my world. I even found a pair with teeth and eyes. Bill liked them best of all.

Now THOSE shoes make a statement!

Looking at my humble, Dust-Bowl Brown, New-Best-Friends, they don't look so bad after all. And they feel marvelous!

P.S. Echo is hanging in there. We made it through one more night peacefully.

Echo, would you like mustard and relish with that?

When Echo was an adolescent, I enrolled her in agility classes to burn off some of that excess energy and give her a bonding experience. She was very fast, extremely smart, and completely intolerable to all the other dogs. She would bark at them when they made mistakes. She didn't want to wait her turn to do the course. The hardest agility move for her was where she was required to lie down and stay in one place for 3 seconds. The training reward in the class was small pieces of hot dog, which we humans held in our mouths, (because our hands had to be free for gesturing to our dog), and doled out when the dog completed a move successfully.

I remembered this yesterday, and though she hadn't eaten much of anything for 36 hours, she perked up at the smell of Nathan's franks and ate a bowlful of small pieces. She even kept most of it down for about 18 hours. When we got up early this morning to take Bill to the airport, she upped a little undigested hot dog, but most of it stayed in her. But this also tells us that her digestion is slowing way down, and we're becoming more convinced that we're dealing with a tumor, not Lepto.

We still need to know whether it is Lepto (or it could be Lepto AND a tumor), because it is a contagious disease that could transmit to us. If the test result is positive, Bill and I will have to take a course of doxycycline ourselves.

Today, the only thing she would eat was a bowl of cooked, crumbled hamburger meat. But she's drinking clean water again out of her bowl in the house, and she went for a slow, short walk up the back hillside this afternoon. She's sleeping comfortably on the couch now (she can still get up and down on her own).

I suppose the question is "how long am I going to let this go on?" Every time I think she's a goner, she perks up, wants to go outside, or eats something. She is still responsive to us, alert most of the time, wagging her tail when we speak to her. She's trying her best, and I'm not ready to give up on her as long as she isn't in pain and exhibits normal dog behavior.

Bill said his goodbyes this morning and told me he'd trust my judgment, if I thought she needed to be put gently to sleep at some point this week. She hasn't given up, so I'm not going to give up on her either. I'm not there yet.

Still holding on, Waiting & Hoping...

I don't know what to tell you about Ms. Dog. She is steadily getting weaker, has no interest in even the most esoteric of our food offerings. We're now into the mail-order specialty sausage, cottage cheese, ice cream, bacon--what normal dog would turn her head away and get up and walk away when you held a piece of bacon under her nose?

We've offered everything we can think of--she perks up when we talk about it, she sniffs it tentatively, but then turns away with an expression like "Nope, that's not it." She's waiting for us to bring her something worth eating, I guess.

Bill's idea this morning is...wait for it...Cat Food. Whenever we visit a house with cats, Echo's first order of business is to find the feline food and eat it all up--preferably while the cat is watching of course. There's a hint of the forbidden (because we always scold her for this behavior), it's stinky, and might interest her nose enough to get some nutrition down her.

In the meantime, we worry and we sigh and we fret. There just doesn't seem to be much we can do for her.

Bill is headed to Philadelphia tomorrow for a one-week temporary assignment as First Engineer on an old friend, the USNS Pollux, an SL-7, the biggest steamship on the planet. I once visited Bill on this ship down in New Orleans, and was amazed at its size and complexity. To give you an idea of the scale of this leviathan, I took a walk one morning from the stern to the bow and back again. It took a full 15 minutes of brisk hoofing. The ship's holds of seven parking garage-type stories can carry an entire Army Division's equipment in one cross-ocean trip, including helicopters (with the props folded down), Humvees, Bradley Fighting Vehicles, Strikers, tanks, etc.

Bill was aboard the Pollux, anchored near her sister ship USNS Bellatrix, immediately after Katrina's landfall. The Bellatrix could not move out of the way of the hurricane because the main shaft was torn apart, so they battened down the best they could and rode out the storm. For months post-Katrina, the ship made fresh water from its de-salinators for the city, pumped its own diesel fuel into emergency fire and police vehicles, set up a dialysis facility on-board for hospital patients to come to, and housed and fed visiting veterinarians who were caring for all the abandoned pets. I'll bet you never heard any of that on the news, did you? The captain made these executive decisions on site, and didn't consult with FEMA or even the Navy in Washington DC; he saw a need, and did what he thought was necessary.

I'm sorry to see Bill go for the week, but I am also immensely proud of the work he does. If they need him, I'm all for his going to contribute. He'll be back on Friday or Saturday, and we'll see where we are with our own domestic dog-drama then.

Echo Updated

Once again, we trekked Echo over to Church Hill for a vet consult yesterday afternoon. She was so excited about riding in the car, she tried mightily to jump into the driver's seat, but her back legs failed her. Bill had to lift her into the back.

After much waiting and finally much discussion with the vet, our best guesses are that she has a tumor (spleen, liver or kidneys) or a bacterial infection called leptospirosis. If she has a tumor, there is a 75% probability that it is malignant and will kill her. If she has lepto, it is treatable by a six-month course of doxycycline. The smart and economical choice seemed to be to rule out or confirm the lepto infection, rather than doing ultrasound or exploratory surgery, looking for a tumor.

So now we wait. Test results will be back sometime in the middle of next week.

She is getting progressively weaker, because she is not eating much of anything. We were up at 5 this morning, cleaning up the results of dog barfing. I'm not even sure she could tolerate 6 months of antibiotics, as they mess with her tummy so much. But we are hoping for a lepto diagnosis anyway. The other prognosis is just too grim and final.

Echo ate about a tablespoon of tuna in water this morning for breakfast. She appears to like it straight out of the can, as opposed to having it in a clean dish. What is up with that?

Back to wait-and-see.

Library? No, it's a Video Rental Store!

Last night, I felt like I knew what I was doing for the first time at work. I moved calmly and seamlessly from one task to another, didn't get irritated at anyone, didn't make any obvious, flustered mistakes, and didn't once apologize and tell anyone that I was new.

For starters, my feet didn't hurt. I swallowed my shoe-pride and bought a pair of ugly brown Crocs on Monday. I can live with the lack of style. I can ignore the color. Saints-Be-Praised, my dogs aren't barking anymore.

Second, I took in a container of leftover Venison Bourguignon and shared it with (read: pushed it upon) my co-workers. I put some in a cup and heated it up for my boss, so she could eat while she was swamped with computer work at her desk. She is now my biggest fan. Everyone else swooned a bit too. I am IN! (Thank you, Julia Child).

Third, I started identifying the small things that drive me crazy already, and working on solutions to those problems (because these things also drive everyone else working there a little nuts).

Who knew that the local library is actually the new Netflix/Blockbuster? Daughter Juli tells me that all the 'net blogs are touting money-saving ideas, such as "Don't rent videos, borrow them from your local library!" She says that she recently read a news article that said that Blockbuster has closed more than 800 stores, and that libraries are now the primary source for renting movies.

All I know is that when I got the library job I was thrilled, thinking that I'd be around all those BOOKS! I'd be helping people find research materials, deciphering the Dewey Decimal system, and sharing unlimited access to the written word with the world.

Instead, my two main activities at work are: managing traffic for public computer usage, and dealing with eleventy-billion DVDs. I check them in. I take them out of the cases, slip them into sleeves and file them alphabetically in the storage bins. I re-shelve the empty cases. Two minutes later, someone brings the same case back to the desk. I check it out. I find the disc in the storage cabinet, take it out of the sleeve and put it in the hard case again. Again and again. Over and over.

Yesterday, instead of re-stocking the empty cases on the shelves, I just let them pile up on the desk until they literally started sliding to the floor. My thinking was, if I put them back, people will just check them out again, and I was too busy to deal with it (the library was a madhouse since we had been closed for the prior three days). I was too busy defusing computer conflicts
("but I can't wait until someone else is done!") to get upset over movies.

The other problem is the DVD shelves themselves. They are too deep for the cases, so every time I do re-shelve, I have to re-straighten everything, pull out the cases that have slipped to the back, re-alphabetize everything again and shore up the sliding mass of movies. About the hundredth time I did this yesterday, I thought (in my best internal Jimmy Stewart voice) "now wait just a gosh-darned minute!" There must be a better way to do this.

I got out the yardstick and did some measuring. All I'd need is 12 pieces of wood, 1" x 2.75" x 35.25" long. I could slide these spacers into the back of each shelf--then, no matter how many times people messed with my DVDs, they would slide in to the spacer and STOP! They would all go to the edge of the shelf, and no further. Yes, I would still have to shore them up laterally, but no more digging and slipping and hiding!

I asked the director if this would be a good thing. She countered by telling me to just go to Henard's Lumber and get what I needed on the library's account. She also said "I like people who take initiative!" I felt like I had just won a gold star in Library!

And who knows, maybe someone will check out a movie, and then miraculously decide to read the book. It could happen, right? It would be a start at least.

A little knowledge is a sad thing

Echo's abdomen is suddenly swollen, and when Bill brought it to my attention last night, my first thought was "spleen." We looked at dog anatomy on the internet--everything is so packed in together, it's hard for amateurs to discern between liver, kidneys and spleen. Bill went online last night and started researching dog medical issues. The news is not good.

There's not much we can do for Echo. The vet can do an ultrasound, or surgery to remove the spleen (which is also exploratory for other issues such as liver and kidney), but the bottom line is that Echo has all the symptoms of a spleen tumor, and 75% of those in older, large-breed dogs are malignant. Even if it's not cancerous, the surgery itself is extremely dangerous and the long-term prognosis is that you can extend the animal's life by only a short time. Most dogs in this situation die suddenly from an internal bleed (this is what we are pretty sure happened to our first dog, Loki.), or slowly because of mini-hemorrhages from the tumor. Performing surgery just hastens the process, costs a ton of $, and gives the dog more discomfort.

In the meantime, poor Echo is just as sweet as can be, but getting weaker. She's not eating or drinking much (pressure in the stomach squeezes the other internal organs), and last night, she couldn't make it up the final six steps to the loft--her back legs slumped on the landing, then she turned around and went back down.

Bill and I had a little cry, and went to bed. This morning, Bill went down to the pond with a shovel to pick out a spot for her final resting place. We're determined to support her as long as she appears reasonably comfortable, but we're coming to the realization that the end is probably coming soon. We've pretty much given up the idea that she's going to recover. We love our loyal companion, so we will try our best to do right by her.

Feeding Miss Doggie

Echo had a good day yesterday.

She went down to the pond to see her dog-friend Bear, and the two of them spent some time sniffing and peeing on each other's property. She made it back up the driveway, although she took her time and did it slowly. Her eyes were quite yellow, but she had a decent appetite.

Echo seems to be tempted by novelty foods. Yesterday, it was a can of albacore tuna packed in water that got her attention, fed to her bit-by-bit. She also seemed interested in Bill's Rice Chex, so she tried 3 small handfuls of that (with vanilla Ensure as the liquid). She drank about a litre of water--but not from her dish, of course. No, she likes the nasty rain water than collects in the folds of a tarp in the yard. She took a few pinches of grated cheese from my hand. She had no interest in egg, milk, Gatorade, rice, chicken or anything she ate enthusiastically the day before.

I'm thinking we need to get back on a regular feeding schedule, instead of trying to get her to eat a little all through the day. Maybe she'll eat if she is allowed to get a little hungry? She also smells very bad. I know that dogs don't sweat, but she really needs a bath. We are reluctant to stress her out by putting her in the tub, but it may be unavoidable. Bill and I cleaned our house yesterday instead, trying to keep the doggie smell down to a minimum. He vacuumed, while I swept and mopped the kitchen and bath floors, scrubbed the crud off kitchen cabinets and wiped tables.

Today I am off to Kingsport for an acupuncture treatment, shoe shopping (still trying to find something that doesn't kill my feet at the library) and a run to the liquor store for Marsala, brandy, tequila, and wine, for cooking.

I like cooking with wine. Sometimes, I even put it in the food...

Venison Bourguignon - OMG, can stew really taste this good?

I spent yesterday cooking, oh-so-happily.

After seeing Julie & Julia, I have been obsessed with the legendary Boeuf Bourguignon recipe that got Julia Child published after ten long years of recipe testing. I know it sounds ridiculous, but I have never cooked even one recipe from Child's Mastering the Art of French Cooking (1961). I was, in a word...intimidated.

I know. I have a Culinary Arts degree, I am an excellent cook, but somehow, I just never took the Julia Child plunge.

I watched Julia's The French Cook on PBS when I was in elementary school. I would walk my brother home each day for lunch (our new school had no cafeteria, until I was in fourth grade), and I would make lunch for the both of us. We would then munch away the blistful hour, watching Jeopardy! with Art Fleming, and then Julia's show. My dreams from childhood then became: appearing on Jeopardy! and learning to cook like Julia.

Having made it as a contestant on Jeopardy! in 1994 (and acquitting myself honorably), the only thing left was to cook like Julia. I was going to school in 1994-95 in Culinary Arts at Adirondack Community College. Though we made tons of classic French sauces (in the footsteps of L'Escoffier), we never made anything with them. Our experiments ended up in the soup pot for the cafeteria, who controlled our budget.

After seeing the movie, though, I was inspired. I checked out Julia's book and vintage videos from the library, and decided to take the plunge. Having a freezer full of venison, it seemed like a great place to start.

First, you need to know--the stew was AWESOME. My whole house smelled terrific while it was cooking, and I spent the whole day salivating. What I thought would be complicated, was so easy. Though detailed, Child's instructions were step-by-step, with no surprises. I was tempted to fiddle with the recipe, but squelched that impulse, wanting to know how it would turn out if I just followed it exactly. It was perfect.

And even if you have no venison (my only divergence from the printed recipe), it would be excellent with a cheap cut of beef (use Lean Chuck, Sirloin or Top or Bottom Round steak):

Boeuf Bourguignonne by Julia Child

[Beef Stew in Red Wine, with Bacon, Onions, and Mushrooms]

6 oz. chunk of bacon - Remove rind, and cut into lardons (sticks, 1/4" thick & 1 1/2" long). Simmer rind and strips for 10 minutes in 1 1/2 qts. of water. Lift out bacon pieces and rind to a side dish and dry on paper towels. ( Pam's note: Keep water boiling and add 24 small boiling onions for 10-30 seconds. Drain and rinse onions in colander under cold water)

Preheat oven to 450.

In a dutch oven or 5 qt. pot - Saute the bacon in 1 Tbls. Olive Oil over moderate heat for 2-3 minutes and brown lightly. Remove bacon & rind to a side dish with a slotted spoon. Reheat fat until almost smoking.

3 lbs. lean beef, cut into 2" cubes - Dry the meat well in paper towels. It will not brown if it is damp. Saute it, a few pieces at a time, in the hot bacon fat until nicely browned on all sides. Add it to the bacon in the side dish.

When all the meat is browned, add 1 sliced carrot and 1 sliced onion to the hot fat. Brown the vegetables and remove to the dish with the meat & bacon. Drain all fat from the dutch oven.

Return meat, bacon and vegetables to dutch oven, and toss with 1 tsp. salt, 1/4 tsp. fresh ground pepper, and 2 Tbls. flour. Set dutch oven in the lower third of the hot oven and bake for 4 minutes. Remove, toss again, and return to oven for another 4 minutes. (This browns the flour and covers the meat with a light crust). Remove from oven, and turn oven down to 325.
Add to the meat in pot: 3 cups full-bodied young red wine (I used 1.5 cups of cabernet, 1.5 cups shiraz), 2-3 cups beef broth, 1 Tbls. tomato paste, 2 cloves mashed garlic, 1/2 tsp. crush thyme, 1 crumbled bay leaf, the blanched bacon rind. Bring to a simmer on top of the stove, then cover and place in the 325 oven for 3-5 hours. Meat is done when tender to the fork.

While the meat is cooking, prepare onions and mushrooms:

Peel the 24 cooled onions by cutting off both ends and removing peel with fingers. Poke paring knife into the root end about 1/4", cutting a "cross" so the onions won't burst when cooking. Heat 1.5 Tbls. butter and 1.5 Tbls. canola oil in a saute pan. Wait until the butter stops foaming, then add onions. Roll them around by shaking the pan over medium heat for about 10 minutes, browning on all sides.

Add: 1/2 cup beef broth, 4 parsley sprigs, 1/2 bay leaf and 1/4 tsp. crushed thyme. Cover and simmer at very low heat for 40-50 minutes, until tender but still holding shape, and stock is evaporated. Set aside.

Wipe 1 lb. mushrooms with paper towels and cut into quarters. Heat 2 Tbls. butter and 1 Tbls. oil until foam subsides, then add half the mushrooms. Shake pan and toss for about 5 minutes, until browned. Remove to side dish. Repeat with remaining mushrooms. Set aside.

When meat is done, remove from oven. Strain all liquid into saucepan, clean the dutch oven, then put the meat and vegetables back into the pan. Add the reserved pearl onions and mushrooms.

Heat the liquid to a rapid boil, skim all the fat off with a spoon, and reduce to about 3 cups, until it is thick enough to coat a spoon.

[Pam's Note: I was hungry at this point, so I hurried it by adding beurre manee, equal parts of soft butter and flour, stirred to a paste and whisked into the broth until it thickened]. Pour sauce over meat and vegetables and toss to coat. Simmer for 2-3 minutes over medium heat, sprinkle with chopped parsley, then serve.

Accompany with salad, the rest of the red wine and good crusty bread & real butter.

Fabulous.

(It's supposed to be even better the second day, after being refrigerated. Just reheat gently, stir gently and serve).

Pam: Bring to a Rapid Boil, then Simmer for 24 Hours until Thoroughly Annoyed

Echo update: She is eating less and less each day, and getting progressively weaker, unfortunately. Bill and I have decided to let her set the pace and trust her dog instincts. Last night, she gobbled down some cooked rice, but eschewed her latest favorite, scrambled egg. This morning, she lapped up some egg and milk mixture and ate some cooked venison, but turned down bread, kibble, rice, scrambled egg and yogurt. Right now, I'm cooking a chicken breast and hoping that will tempt her today.

In the meantime, I have been unbearably steaming in my own body heat. The Effexor and Spruce Lignan no longer keep the constant hot flashes at bay. I am waking up several times a night in a soaked nightgown, staggering out to the couch to lie under the fan. I sweat like a marathon runner at work. It never abates, I am hot-hot-hot, all the time.

Imagine my thrill when the latest issue of Cure magazine touted an article on cancer treatment-induced hot flashes! At last, some new ideas! After plenty of yada-yada, yeah I know what causes them, here's what the article cheerfully concluded:

"Simple lifestyle changes may help reduce the severity of hot flashes. Experts [ahem] recommend trying to avoid circumstances or activities that may trigger hot flashes. Stress is a frequent trigger, so practicing stress-reduction techniques, such as meditation or yoga, may be helpful. Other suggestions include wearing lightweight cotton clothing and sleepwear, staying hydrated, and avoiding alcohol, caffeine, and spicy foods."

Gee. If only I had known this before! [insert major sarcasm here]

I threw the magazine clear across the room. Thanks a lot, Cure. Sheesh. No help here.

I am so darned tired of being CHEERFUL about this. The few times the hot flashes stopped, (at first with the spruce lignan, then at first with the Effexor), it was such a relief I almost wept with gratitude. Then they came back with a vengeance. Like a present, snatched away, just as I was getting ready to open it. Hot, cold, hot, cold--I pile on clothes, then fling them off (at home anyway; I just fan myself and sweat vigorously at the library).

The last time I was at the oncologist's, he asked if I was taking the tamoxifen.

"Of course," I replied. "How can I argue with a 41% increase in survival rates? Who wouldn't take it?"

Dr. DaSilva allowed that a great many of his patients just stop taking it because of the side effects. I got a good girl award for being a stoic, compliant patient. But I wonder how long I can continue to live like this. Some days, it's downright unbearable. And the aromatase inhibitors he wants to change me to have even more heat potential, plus the added bonus of bone loss, bone pain and heart arrhythmia. Oh joy.

Bill's suggestion was to tell my nutritionist/biochemist Dr. Veltmann in New Mexico about the proposed change in meds. Dr. Veltmann has me peeing in cups and spitting in tubes to measure whether I am still pre-menopausal (suggested by my extreme heat reaction to the tamoxifen) or truly now in menopause. I will know the results of all these genomic tests in early November, just before my next oncology check-up.

I am trying to be a smart patient about all of this. But some days (and nights), I just want to climb into a vat of ice and stay there.

Echo, the Dog with 9 Lives...

Just as soon as we start thinking this is the end, the pup fools us all.

Yesterday morning, we were at a nadir. Yesterday afternoon, Echo went out to pee, then hiked up the mountain in back, sniffing out squirrels, marking territory and generally acting like a normal dog. She ate a variety of fresh foods (chicken, venison, egg), and also took some kibble soaked in milk. I stopped the antibiotic and re-started the Sam-E and milk thistle to support her liver.

This morning, her eyes are white again. When I let her out, she circled the house and then headed down the driveway for the pond. I called her back, and she made it slowly all the way back up and then up the 26 steps. She was tired, but she ate a breakfast and laid down for her morning nap.

Weird and yes, wonderful. We are dog-controlled yo-yos. One day at a time. Learn the lesson, one more time.

Poor Echo

This morning, Echo's eyes are jaundiced, a sure sign that her liver is shutting down. Bill and I have been talking (and crying), and we've decided to keep her as comfortable as possible and let her go in peace, on her own schedule. It's very sad.

She gobbled down some venison this morning, and took some bread soaked in egg and milk. Last night, she enjoyed some of the plain yogurt Bill went out to get at Food City at 10 pm. She may yet recover, but we are preparing ourselves now to deal with losing her. We're back to wait-and-see.

Relapse

We thought we were on the road to recovery, but this morning Echo seems worse again. This may be a "two-steps-forward, one-step-back" kind of thing. I may have let Bill's panic push me into giving her more food than she could handle yesterday.

I am off to work my first full day at the library at noon. We'll just have to take it one day at a time and see how she does.

Crisis Abating...

It looks like we may have Echo for at least a few more thousand miles. She's eating food and drinking water. She's still terribly weak, and her spirit has more gumption than her body has stamina. But she's going outside and making it back in, to flop on the couch or the futon.

However, it looks like I'm going to be cooking for the dog in perpetuity. She will not eat dog food of any kind, canned or kibble. She will eat scrambled eggs, boiled chicken, and the aforementioned venison. I have a recurring vision that soon she'll be demanding turkey dinners with all the trimmings, Beef Bourguignon, Chicken Kiev and Veal Oscar. And ice cream for dessert.

If it means I still get to have my companion animal around for awhile, I'll do it.

Reason to hope

We are encouraged this morning. Echo is drinking water, keeping her meds down, and acting more like a dog with a reason to live. She had a big breakfast of lightly cooked venison and scrambled egg. She even went up the mountain and barked at a couple of turkey bow-hunters that were on her property illegally. They hustled off the mountain like they knew they weren't supposed to be there.

I decided to start feeding her the venison last night. I was making meatballs with a sauce made out of my garden tomatoes, and it occurred to me that the venison might be the leanest, least-contaminated-with-chemicals meat I had in the house, perfect for a sick dog. She does love the taste of deer meat.

She ate a little last night, but clearly showed a preference for the raw egg & milk batter with bread. But this morning, she really scarfed up the meat, mixed with a little of the dog food that the vet gave us to try.

A few more days and we'll know for sure. But right now, she's upstairs in the loft with me, sitting by the open window and watching her yard alertly. Her fever seems to be gone, and though she's still weak, she's acting more normally.

A Positive Update

Echo has kept her meds down so far this morning. She drank a little more milk & pepper, then ate some kibble soaked in the mixture and fed to her by hand. A little later on, she enthusiastically gobbled up small pieces of bread, soaked in egg & milk. I stopped feeding her for awhile, waiting to see if she could keep it in her stomach.

Bill has gone to check out the 12-mile long garage sale up on the Clinch River Road. When he left, Echo came up the stairs to the loft to be with me while I worked on the computer. She spent some time looking out the window, then climbed up on the futon. She is now sleeping peacefully on her blankie.

I have hope that this is all a positive sign for her eventual recovery.

Gran's Remedy

Yesterday was doggie-hurling day. I was at work, but Bill spent the day cleaning up after the dog. He says we may need new carpets.

Everyone is worried about Echo. My mom called after remembering that her mother used to give the family German Shepherd a concoction of warm milk and black pepper when his tummy was upset. We were desperate enough to try it--and Echo lapped it up and kept it down.

Our latest worry is that she is not eating or drinking enough of anything to sustain life. She has already lost about 5-10 pounds. The big decision today is whether to take her to the vet, or stay at home and wait it out.

Echo had more milk and black pepper for breakfast, but is refusing solid food. This wait-and-see stuff is very wearing on all of us.

Still on Dog-Watch

We are still waiting for Echo to recover. In the mornings, she seems like she's getting better. In the afternoons and evenings, it seems as if she's at death's door. Bill has been driving her to the vet every day for a week, and we're tapped out on the dog budget, both emotionally and financially. Today, something has to change.

Last night, I fed her boiled chicken breast and coaxed her into drinking water by giving her the water the chicken was cooked in.

This morning, she went out with more enthusiasm than we've seen in awhile, and actually walked up into the woods, sniffing curiously and marking territory.

We're waiting and hoping...

One Sick Puppy

Echo is a fighter. She's miserable, but she keeps on trying to rally her strength. Once again, we traveled to the vet yesterday morning. Dog-doc gave her a litre of fluids via IV, shot her up with antibiotics, and Echo came home exhausted. She spent the day and evening not moving, flopped out on the floor.

She did drink a little water last night, when I cupped it in my hand and held it under her nose. Eventually, she got motivated enough to lap it out of her water dish, when I pushed it close so she could reach it without getting up to her feet.

Sometime in the night, she moved herself up onto the couch! This morning, she perked up her ears when I asked her if she wanted to go out. She got herself off the couch without help, went outside to do her business, and came back on her own. This is a huge improvement.

Bill has taken her to the vet this morning by himself, as I have to be at work at noon. We're just hoping she will respond to all this medical intervention and start getting better soon.