4th one down

Good news today.  The results of the pathology of the needle biopsy came back negative for malignancy.  That is quite a relief.

Then I had my last infusion for this set of treatments.  First I had a meeting with Dr. C that went really well.  I had taken the time to organize the information that I had from several studies using rituximab, and write out a bunch of questions, rule outs, and thoughts about how I might want my treatment to continue.  As I asked questions and he looked at my notes, we really came to the same conclusion.  Because rituximab doesn't tend to show reduction in it's efficacy with multiple treatments, we can use it in a maintenance program.  So we made another appointment for a month from now to see how things are going, and we will monitor for symptoms  closely.  In six months we will do another 4X treatment of rituximab as a maintenance dose.
There is always targeted radiation, and toxic chemo regemins if things get worse not better, and there are newer monoclonal antibody drugs coming out as well. So physically, this one is looking pretty easy.

Cancer is just one more challenge of life

...and a big one.  Some how I didn't get in the right line when the LIFE manuals were being handed out.  It seems to me a lot of people have things more figured out than I do.  Oh well, one day at a time, right?

So my treatment yesterday went great.  I had the company of one of my housemates and my cousin for a couple of hours.  Ran the rituximab in at full speed with no problems.  No side effects afterward other than the groggy from the benedryl.

So now that I am getting near the end of treatment, I have to start getting back to the rest of life, adjusting to whatever my new normal is going to be as a 2x cancer survivor.  The jumble of things I left behind makes it hard to decide what to prioritize.  I had a job interview for a part time position that will be really good experience, but not many hours, and another opportunity, so I guess I will have to paste things together and make it work.

I think I am to the point of just rambling now.  So I should probably just end this post.

I do want to say a big thank you to all of you who have called and checked in and been generally supportive through all of this.  It means a lot to me.

Vicarious loss

I received some sad news today, more about sad for someone else, not me, but when that someone else is a wonderful, supportive, teacher and friend, I can't help but feel the loss some how myself.

Cindee is a wonderful, deep, intelligent, and most of all loving individual who has been my teacher, guide, and  friend since meeting her 2 years ago.  We have had marvelous discussions about spiritual development, theology and how psychology/clinical social work interacts with the divine and humanity.  Her discussions and class projects have helped me to know myself better, and embrace the goodness in myself and other.  She has given me the opportunity to grow as a person, a clinician, and a teacher, and for that I am eternally grateful.

Through all of that Cindee has become my friend, and enthusiastically has supported me, distracting me with conversation while I get my infusions at the cancer center.

Tomorrow I will miss her though the loss I feel will be much more than her physical presence.  Last night I heard the news that her husband Neil was in a traumatic car accident, and today I heard that he died Monday night.  I went on with my day, I had a patient to spend the afternoon with.   Sometimes the patient naps quite a bit and I had some quiet time.  Grief washed over me contemplating my friends loss and it was only the professionalism I have learned over the last couple of years that kept me from breaking down and weeping at that moment, I took in a deep breath and allowed the feeling to wash over me for a moment and blinked away the tears starting in my eyes.

When I left the home I called another new and dear friend, Barbara at the cancer center, who graciously agreed to change her plans and talk with me about Neil's death.  On arriving at the cancer center, we hugged, we shared the emotions and talked through the spiritual implications, talked about the weight of working in a field that is regularly faced with the disappointment of death.  We talked about what makes a for a good death, and shared experiences.  We talked about self care.  I have been blessed to be well supported with mentors and friends.

I came home and walked the house mate's dog, then returned home to indulge in some fruit and dark chocolate.

My mind is still chewing on things, my heart is aching for my friend, though only a fraction of the pain I am sure she feels.

Cindee,  I hope you and your boys are supported in the arms of family and friends, and in the depths of your grief I hope you experience the fullness of the peace that transcends our understanding and are embraced in the loving heart of the divine.

Poke, poke, poke

After being disappointed by the denial of a fine needle biopsy with the lymph node, my dream was finally realized today with a needle biopsy of the thyroid node.  You see I have a amazing collection of procedures, many that are no longer used, so adding another one was quite a pleasure. Though not completely unpleasant, the procedure was really mostly painless, and I only have a little discomfort left from the swelling.  It was nothing compared with a lymphangeogram of oldeI will get the results back as early as the end of the week, but most likely early next week.  So stay tuned.....


For those faint of heart and squeemish, this is probably as far as you will want to read.  I will describe the procedure in more detail following for those that might be interested in what it is like to have one.

First of all, an intern, which is only fair for how much interning I have done, took some snapshots of the mass just to make sure it hadn't changed significantly from the last time.  The node was located, everything was reviewed by the imaging technician and the radiologist was called in.  I signed a consent and away we went.  The radiologist and the technician relocated the node one more time and marked the skin where they wanted to penetrate the skin.  Then the tech wiped antiseptics all over my neck and her equipment as the intern laid out supplies and the radiologist readied himself.  Then a quick poke and little burn with some anesthetic.  A minute later he was back saying, "tell me if this hurts."  The technician brought up the ultrasound so he could see exactly where he was going, there was a little pressure pain as he pushed the needle into the tumor a half dozen times before pulling it out.  Apparently they could see the line the needle made.  The did the same with two more needles getting different parts of the tumor.  The doc seemed impressed that I didn't bleed much.  They wiped the gel off and put a clear bandage across my neck and sent me on my way.  Compared to other things, I am a pretty big fan of this procedure.  Frankly, I would rather have a needle biopsy than a urinary catheter any day.  Another one for the scrap book.

Information treatment number 2

Today was treatment number two and it went off without a hitch.  Because I had a slight reaction last week, they used a slower rate, no reaction this time, so didn't need the extra benedryl.  I am just a little sleepy, but not too bad today.  I will take another Tylonol so I will have less acheies this evening. I may have a part time job opportunity so I may change the day of the week.  We will see, and I will keep you up to date.

My professor visited with me again and we had a marvelous conversation that bridged life and theories.  It is always such a pleasure to have those conversations.  I can't think of a better way to pass the time in the chemo chair.

Treatment update

I ended up roadtripping to Longview and PDX for a whirlwind trip mostly to do a favor for a friend.  I turned out to be a really fun and rewarding trip.

We got an unexpected invitation to stay in PDX Monday night and visit, so I didn't get back in time to do the needle biopsy.  It has been rescheduled for 8am next Tuesday morning.

Tomorrow is rituximab treatment number 2.  Check in at 8:30.

Treatment update

After the infusion on Wednesday I had a few cold/flue like symptoms that evening, but went to bet early, which was pretty easy with that much benedryl in my system, and got about 10 hours of sleep.  Physically I have been feeling fine the rest of the week and into the weekend.

So next week we have the needle biopsy of the thyroid on Tuesday morning and then the regularly scheduled infusion on Wed. morning.

A little distance and the new normal no information...just musing

Looking back over the last few days,  seeing that I haven't made a post since Wednesday just makes me think a little.  I guess we all need a little bit of distance from our difficulties from time to time.  Having both experienced and studied trauma and grief that is one thing I am certain of.  In grief work they call it "portioning."  It is something children do naturally but many of us adults may have developed glitches or defenses that stop this mechanism from working.  Still,  I bet you all can think of a difficult scenario that you faced, and some time in that work, you reached a limit and just had to set it aside for a while and come back to it.  Often when you come back to it, you may have had a new perspective on the problem or at least some renewed energy to face the problem.

With the blog, I think part of it has to do with with acceptance, or what lack of acceptance I am still dealing with, as well as portioning and giving myself a little break from directly thinking about the cancer.  Though it has similarities to denial and one might conceptualize a spectrum, it isn't contradictory to the event, but more like a side track.  When functioning completely healthy, it is like a pitstop in a race, a necessary reprieve to refuel and perform maintenance.  I can identify both healthy and unhealthy elements in my past few days.  I have habits of avoidance in my coping tool bag that sometime don't work well for me.  In this situation, my plan of action is already in place and is not likely to change significantly in the next 4 weeks.  So this one really can go on the back burner and allow me to catch my breath and focus on other things for a day or two, i.e. healthy coping.

The more unhealthy part would be avoidance of communication to reduce the sense of reality.  As I posted before in "Tomorrow..." there are somethings that tend to make situations hit home and feel more palpably real for each of us.  They may be common or distinct to any individual or situation.  For me, and from what I understand generally common, it the fact that writing about something and especially having others read it, tends to bring it from thought in my head, feelings, worries, to something much more real.  So, avoiding communication about something can be a very real denial defense.  It come down to "I don't want to tell you because I don't want to believe it myself."  Though I found other things to do instead of writing in this blog, I was still putting myself in and allowing social situations, and telling people about my experience.

With traumatic situations, as we accept them and they become real in this way, they change who we are.  The nature v. nurture or genetics v. experience debate is well fought, from metaanalysis it looks as though somewhere between 65-80 percent of what we might call our personality or conscious comes from genetics.  That is why we have solid examples of identical twins raised in different cultures with identical mannerisms.  Experience shapes the remaining part of us, and as we develop maturity and awareness, our intention can shape us as well.  Such a dramatic event such as cancer, the death of a close loved one, losing a job unexpectedly, the list goes on..., can significantly change a person.  Events before the age of 25 tend to have an even greater impact because they can have the added effect of developmental interruption.

The real on the other side of the event is never the same as the real before, and this change, especially when so abrupt, is what we resist with denial.  We never really get over it or go back to the way things were, because things aren't the way they were.  I love the quote from Oliver Wendell Holmes, "The mind, once expanded to the dimensions of larger ideas, never returns to it's original size."  I believe this is true for traumatic experience as well, really for any significant experience.  For someone who grew up in the plains of south Dakota, it may be as simple as trekking to the coast and seeing the expanse of the ocean.  Suddenly the world is more expansive and will never be a small again.

I am a cancer survivor and I could sooner forget the ocean is there.  I have experienced cancer from many sides and vantage points, it is woven into the fabric of my being.  Even when I was cancer free for 22 years, it was still apart of my daily life.  From seeing and feeling the scars, to taking pills, even my body can't just get over it.  But then is life really just about "getting over" the tough times and enjoying the good times?  What if we can find joy in the tough times just as some enjoy the resistance of a workout?  What if developing spiritually isn't about living up to an external structure, but rather about being open to the maturation and change that occurs with the experience of life?

In the business, one phrase we use for the whole experience is "new normal" though the sentiment isn't really that different than "getting over" or "getting past" something, it also acknowledges the fact that this event is significant enough to catalyze real change in our being.  Though the essential components are still the same, we may be as different on the other side as a recycled pop bottle when it becomes fleece fabric.  Material makeup is still the same, but the shape, the feel, the texture, even the purpose may be very different.  My belief is, that even though we don't want these things, and I don't believe God purposes us to experience them, the more fully we can accept them and embrace what our new normal might be, the more we develop as fellow humans, as spiritual beings, and the closer we grow to becoming who we created to be.  If the pop bottle really knew how awesome fleece was, would he really want to be a pop bottle any more anyway?

Having shared the end of this life with many people and their families, and sharing the experiences of colleagues and friends, I have seen the difference between people who are still fighting the resistance and those that understand to some extent, the new normal.  Acceptance doesn't remove the pain, the difficulty of the unfairness of a situation, but it does put those things in a more useful perspective.  I may not be able to swim against the current, but I can use the eddies and flow to get where I need to go.  I hope someday, when I am on my death bed, that along the way I will have learned to embrace the new normal with grace.