Tuesday, March 27, 2007

What’s Opera, Doc?


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Ok, it was between the Monty Python and the Barber of Seville with Karen playing Elmer Fudd to my Bugs Bunny while I massage her head.

But I didn't think I could quite capture the music with:

Da da da duna. Da da da duna. Da da da duna da duna da duna da. Da da da duna da duna da duna da. Da da da duna duna duna da. Da duna da. Da duna da....

Ok, got it? All together now.

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Life of Karen


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Yesterday's random thought for any Monty Python fans.

"Chemotherapy? Good. Out the door, to the left, one chair each."

(from the crucifixion scene near the end of Monty Python's Life of Brian)

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Monday, March 26, 2007

3 out of 4


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Third out of the 4 toughest chemos are done. Not much for news.

Looking over her blood count history, we noticed Karen's white cells were at "critical" again. The printout we were handed last week marked it as "low," but was a different format than we normally received. Turns out it the overall number was identical to two weeks earlier. So we'll have to look carefully at next Monday's counts to see what her window for interaction looks like.

The doctor is not happy with her hemoglobin level, so she will get a weekly shot to help with that (Aranesp). They gave one today and she'll get one when she goes for blood counts next week, then each week until she's done. That could be causing the fatigue she feels the first weekend after chemo.

That's about it. Settling in to see how she does this time.

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Tuesday, March 20, 2007

Ready for Starbucks

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Karen in her new dress just before our anniversary mochas and espresso brownies. Ah, Largo, always an elegant, exotic destination. Not quite the level of sophistication one finds in St. Pete, but then, where is?


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13th Anniversary addendum


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I will say with Karen's avant-garde style and her new, black lace dress, we are ready to set some trends and turn some heads, though we might have to blow this burg to do it.


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13th Anniversary


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Of all the things I never expected to be doing on my thirteenth wedding anniversary, shaving my wife's head has to top the list.

As awkward as it is to say, she looks better clean than with the male pattern baldness she had going the past couple days. Not that she looked bad either way, but I might be biased.

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Monday, March 19, 2007

No Longer a C Student


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Went for blood counts again this morning. No criticals this week, only lows. Which means Karen isn't in the isolation ward from visitors for the week, she just has to cautious. She may even get into work later in the week if her energy is better than today.

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Thursday, March 15, 2007

Shorter Still


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Karen had me do the #1 (1/8") buzz cut this afternoon. No picture this time, at least yet. The next time you see her, she will either look like a militant environmental Swedish volunteer for Medecins Sans Frontieres somewhere deep in jungles of the Democratic Republic of Congo, or a blonder, Rachel Welchier version of herself, depending on the peckishness of her mood.

Our cat, Smoke, is now the official long-hair of the house.

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I Have a Dream (reprised)



I have a dream that one day this body will rise up and live out the true meaning of its immune system: "We hold these truths to be self-evident, that all leukocytes are created equal."

I have a dream that one day on the cells of the white hills of granulocytes, the sons of monocytes and the sons of former lymphoctyes will be able to sit down together at the table of brotherhood.

I have a dream that one day even the state of lymphedema, a state sweltering with the heat of injustice, sweltering with the heat of oppression, will be transformed into an oasis of freedom and justice.

I have a dream....


© 2007 Edward P. Morgan III

Ritual



Every fortnight, she enters the cathedral, part stained glass Sistine, part fighting chapel perched above the gates of Caernarfon with arrow slits adorning its floor like a mosaic.

Each appointment is scripted. She finds comfort in the ritual. She signs her name to the Doomsday Book, waiting in the echoing vestibule until her name is called. In the quiet of the confessional, the priest listens patiently then prescribes her biweekly penance.

From the closed chamber of the confessional she is guided to the openness of the presbytery where choir monks tend the high alter. There the ritual goes into motion with blood counts, the reading of vital signs, more blood sacrificed for a divination. Should the numerology augur well, the port is re-baptized in the sea.

A pinch of nightshade soothes and prepares her before the demon-hunters are introduced, a tube of the Red, a bag of the Clear. The Red is reluctant and volatile, requiring the sister to coax it in by hand. The Clear is more amenable, dripping and clicking like the well-fingered decades of a rosary. Both are powerful inquisitors charged with ferreting out malignancies wherever they may lurk or hide. They pursue their mandate militantly, unconcerned with the innocent sheltering among the guilty. The innocent receive eventual redemption, the guilty eternal damnation.

As the Hospitallers continue their ministrations, she accepts a communion of saltines and grape juice to appease the lesser demons stirring in her stomach while an anonymous quartet chants Gregorian whispers into her ear. In a final sacrament a warding glyph is laid across the port sealing it with a sigil broken only when the two-man tribunal rides forth again to terrorize her enemies.

By the night stair, she hears the learned priest in his cell reciting Latin dictation like a mantra, quick and practiced, the repetition as meaningful as the liturgy.

At home, pills form the beads of a private rosary, each dedicated to a different patron, capsules for the saint of nausea, whites for receptor 25, blues for the saint of aches and minor pains. Each is a different murmured prayer repeated at the prescribed intervals, some at Prime, some at Vespers, some following certain feast days, others as a random solace.

The next morning she tithes at the chapel for a short but powerful benediction, a booster to guard the innocent against overzealous inquisitors. In a week, another blood sacrifice, another augury to determines whether she spends her days in cloister or toils the fields beside her lay sisters.

In preparation, she shears her head like a penitent nun awaiting censure, praying her interdiction will be temporary, a time for pensive meditation, an indulgence.


© 2007 Edward P. Morgan III

Monday, March 12, 2007

2 Down


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... less to go. The second appointment went as easily as the first.

A couple interesting updates. With the false positive for one of the receptors, the number of the next round of drugs not only went from two drugs to one, and from every week to every other, it also was reduced from the original 12 weekly doses to 4 biweekly. So two more of this round, then 4 of the next, and it's all good. That should mean chemo finishes by early June. Looks like Dragon*Con is back on the menu, boys.

The other good news was that with the one false positive out of the way, the chance of recurrence over the next 10 years goes way down, 26% if she stops treatment right now, 13% if she completes chemo, 8% if she does chemo and the follow-on Tamoxophin for 5 years. Even better.

Now the not as good news. When the doctor looked at Karen's blood count from last Monday, he said, "Whoa." Her counts dropped faster than he anticipated. Nothing bad, no change in treatment at the moment, but he advised we be very careful on days 5-12 after chemo rather than the 7-12 he was first thinking. Her white count was not high, more the normal range of where she started. Something to keep an eye on but not to worry about.

So, this coming Saturday through the following Friday, we'll be living a bit closer to home where the rest of the time we can come out and play, prudently. That will be the pattern for the next six weeks. Fortunately, the next round doesn't hit as hard, so that may adjust. One stage at a time.

The doctor has said the pattern for this round should continue with the same level of minimal side effects for Karen for the duration with the exception of her fatigue growing as it continued, which was very encouraging. He also looked at her and said, "I spend my day meeting and talking to people and have developed a sense about people. I can see you will come through this fine." That was also encouraging to hear.

Another reason to like the doctor; he likes Belgian beer. Better and better.

That's the news for this round.

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Wednesday, March 7, 2007

Bloodwork


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Talked to the oncologist yesterday about Karen's white blood cell count. They were about where he expected. Indeed the "c" meant critical, primarily for a normal, healthy person like the rest of us. If we show up with a blood test like that off the street, they would be very concerned. With chemo, not so much. It would have to be a lot lower still for her not to get an injection.

He anticipates that the booster shot she got the day after (Neulasta) will kick in after 10 days, so around Friday. When she goes in on Monday, he expects her white count to be 'High."

In the mean time, he told us to be cautious so as not to pick up any bugs to which she is susceptible. No food out, no malls, no grocery stores, limit visitors.

Not sure if this ends up being the routine, on week/off week, but I guess we'll find out as we go along.

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Thursday, March 1, 2007

Opening Volley



The advancing army encircles our castle, severing the roads, blockading all access over land. Only the water gate remains open to resupply and reinforcements, with the odd courier stealing inside with a pouch full of dispatches. Daily flights of pigeons carry communiqués beyond the wall. Those trapped outside form a guerrilla band, the seeds of relief as the enemy grinds its strength against our unyielding stone.

In the gray of the next morning we tour the arsenal one final time before the battle breaks upon us. Scores of arrows sheafed like kindling lean against every wall. Pyramids of rounded stones squat upon the floor between ballista spears stacked in cordwood bundles. Down a narrow stair behind an iron door lay the bunker where we stockpile ammunition for the trebuchet, skins laden with a clear and deadly witches’ brew, terra cotta pots encapsulating Greek fire. In an adjacent workroom, future incendiaries await final, miscible components to endow their lethal magic.

Trailing phosphorus and sulfur, we transport our opening rounds to the battlements. With thick leather gloves, the artillerists pass pots from one to the next as they load the trebuchet. They christen the canisters El Diablo Rojo, the Red Devil, as they are powerful, volatile and crimson bright. Nested within the hoarding, bladders filled from the ocean are ready to baptize our fortification after every shot. Though the sea washes away the Red Devil's sin and stain, each dose etches its mark upon stone.

Enemy mercenaries plot counterattacks when our hero is weak from battle. The apothecary crushes powders with a pestle to gird her against fatigue, preparing soothing infusions should her stomach grow restive, handcrafting a potion which imbues strength for the wearying days between.

Our mage-general anticipates a longer siege, twenty weeks from the onset. Though no 900 days of Leningrad, spring and summer will pass behind the walls leaving only an autumn campaign before winter shrouds the land once more. As a final preparation, we scrub the kitchens and garderobes, mercilessly scouring every corner for rats and other vermin to prevent any outbreak of infection. In siege, disease is a more lethal foe than combat.

With the enemy at the gates, she shears her hair militantly, denying the mutagenic beasts any handhold once the melee ensues. We ready ourselves to lever ladders from the walls and pour boiling oil like disinfectant upon any monstrous mercenaries or their surrogates that dare assail the keep.

There is an excitement that the waiting is finally over, that, at last, the battle is being joined. Later comes the fatigue, the boredom, the sheer monotony describing the day by day of siege, little changing until the relief force rides within sight.

With targets on the horizon, we loose our first volley. Tasting the intensity of our fire, the grendel's most aggressive units, fully one third of its attacking force, throw down their arms, routed from the field. This initial, bloodless victory raises a cheer from the wall, heartening us as we retire to the inner ward, leaving the enemy to the scrutiny of our sentries.

Finishing this latest dispatch, I release a new wave of pigeons, which, like my thoughts, scatter in all directions. Some arrive faithfully at their destinations, while others, distracted by new green leaves, perch in the surrounding oaks, basking a while in the bright, spring day, their responsibilities forgotten, before winging forth once more, revitalized in the hope renewed life brings.


© 2007 Edward P. Morgan III

Caught a Break


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The oncologist just called with a piece of good news. One of the tests that had indicated a marker/receptor for Karen's tumor was a false positive. He didn't want to wait until her next appointment to share the results.

The initial test for Her2/neu (a human growth hormone) indicated the tumor was activated by it. There were three levels to the initial test, 1 indicating no receptor, 2 indicating a weak receptor, 3 indicating strong receptor. Karen came up at a 2. With that, there is a more definitive but more expensive test (the FISH test) that they routinely send out for with a 2 or 3 on the initial test. That was what came back negative.

That means one chemo drug in the second round gets eliminated and the second round may go to every other week injections versus every week.

Her2/neu generally means the cancer is more aggressive, so this coming back negative is GREAT news.

WooHoo!

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