Almost finished with radiation and so far so good

Today I completed the 18th of 20 radiation sessions. The next two are tomorrow (friday) and Monday at 4:30PM. Radiation has gone well - I had to depart work daily at 3 to get to Gainesville by 4:30 (the trip takes longer when you are going with rush hour). Some days when there was an accident or a pile up or a few construction issues on the road that was barely time enough. The last week has been interesting. We have had remarkable low temps for GA in mid February combined with rain on the first day of the cold snap. Fortunately GA state learned lessons from last year's major national news making traffic snafu so they began treating the roads the day before the freezing rain. Two days ago the drive to Gainesville was a bit concerning given it was grey and raining and the rain was freezing on the windshield, signs, trees and so on about as fast as it fell. But the roads remained clear and the traffic was much decreased (lots of places closed) so i got there and back with out problems. The past 2 days driving to and from Gainesville has been sort of like driving through a fairy land with all the trees and bushes coated with crystals that capture the sun and glimmer beautifully. Sort of like driving through rows of Christmas trees only decorated with crystals. Except for the cracked trunks and broken branches where the weight of the ice proved too much for the trees. But ignoring that... It is predicted to get even colder at night and tomorrow - so I am glad tomorrow is my last commute this week. Monday will be the last radiation treatment. I had blood drawn Wednesday this week and will do so again next week - probably Thursday. The outcome of those two blood draws as I understand it will determine when I begin chemo again. I also understand that I will have another CT scan after I complete radiation therapy, presumably looking for changes between when I started and now. Meanwhile last week I had my visit with the Urologist - who tells me that he sees these ureteral obstructions all the time in chemo patients, they cannot be cured by surgical intervention as my surgeon thought he had fixed it during surgery, they likely will get worse with chemo and almost certainly will get worse with radiation and wanted to know why i was not referred to a Urologist earlier. What can I say? I am scheduled to get a stent placed next Wednesday. It will be an outpatient proceedure but performed under general anesthesia. So since I can't drive home (or anywhere for 24 hours thereafter) I will have to recruit drivers. Or maybe I will take a taxi in early and just find someone to pick me up and bring me home afterward. That is the next problem to solve. I am hoping my cells counts are good on the blood draws coming up and I can start back on chemo a week from Monday. If so, I will complete the first of the remaining 3 3-week cycles just in time to head to Rhode Island for niece Louisa's wedding in late March. I decided to bite the bullet and RSVP'd yes, reserved a hotel room and made a plane reservation. But just in case I also purchased the travel insurance so i can get a partial refund if I have to back out at the last minute. So 2 more radiation sessions, another blood draw, a stent placement, probably a CT, and then back to chemo therapy to finish the course starting hopefully within the next 2 weeks.

half way through radiation therapy more or less

Friday I completed #9 out of 20 radiation therapy sessions, making me nearly half way through. So far it is going OK. The 4:30 time spot requires me to leave work by 3 since I have to travel both directions with rush hour traffic. Some days there are pile ups on the interstate and I worry that I left too late. This is why I had requested a morning time slot when I met with the nurse, with the doctor, and again when I met with the techinition. But as seems to be the case with this practice, it made no difference with the scheduling. I had to schedule a urology appointment in Marietta before I knew the time for my appointments with radiation therapy, so I asked for the last time slot of the day since I assumed my Gainesville Radiation appointments would be in the morning. Unfortunately that turned out to directly conflict with my radiation therapy appointments. So when I arrived for the first appointment I asked to reschedule on that day only (which would be this Friday). I was told they could not provide such special treatment that it would be unfair to the other patients. Instead I had to wait until 2 days prior to that appointment to see if it was possible to switch to a morning spot on that day. Fortunatly my primary care doc got Tricare approval for a different Urologist associated with Emory and located in Atlanta and I was able to get that appointment for the first appointment of the day at 8 AM so it should be possible to also make the radiation therapy appointment that same day in Gainesville GA. My experience with this practice leaves me wondering how they could possibly think they are giving me special treatment to the extent that they are disadvantaging others. Fortunately during my daily appointments I just have to walk in, wait often for a very long time but then walk back and position myself on the machine, remove appropriate clothing and lie still for about 20 minutes. The only people I interact with are the technitians and with them only during the time they adjust my position on the machine to make sure things are lined up exactly. So far things are going smoothly. The only side effect has been mild colitis/ileitis leading to occasional rather urgent diarrhea. This tends to happen toward the end of the week and weekend but the 2 days off seem to give my gut recovery time. Just in case I acquired a supply of depends... makes me feel very old. BUt i assume this will get worse week by week but resolve once the treatment is over. I also can feel a bit of tenderness in the area where the radiation is directed, again most noticable on Friday and Saturday. That is not so uncomfortable (at least so far) as to induce use of pain meds, and is sort of comforting in that it assures me that something seems to be having some sort of effect. Hopfully the effect that we want. The fatigue is not too bad. I am able to work daily and am making progress on a book chapter I am supposed to produce by April 1. I do tend to lose concentrating ability about 2:30 every day so I save at least half an hour's worth of little tasks to address in the last half hour before I depart for Gainesville. And I tend to spend my Saturday's napping most of the day in front of the TV, but I did that when I was getting chemo, too, and my brain was less clear. So... Like the colitis, I have been warned this may get worse as the month goes on but so far so good. 9 session down, 11 to go. Then back to the last half of chemo.

First Radiation treatment today

Just finished my first radiation treatment today. I was called last week and told my first treatment would be at 4:30 pm today. I asked about subsequent treatments, and was told I would be given more information after my first treatment today. I explained that in my job I was expected to make arrangements and get leave slips signed in advance rather than just not showing up when it was inconvenient. As a result if they wanted me to return tomorrow I would need to be aware of that appointment in advance of close of business today. After what seemed like a stunned pause, I given 4:30 pm appointments for the rest of this week (Today Tuesday through Friday) and told I would get the remainder of the schedule today. Between then and now I had to schedule a Urologist appointment and was offered 4:30 PM on Friday 3/6 as the first available appointment. I took it, as I needed to find out whether I need a stent and in addition it seemed a safe bet that I would not be getting appointments after this week at 4:30 pm. But today when I showed up I was given a calendar by a cute little nurse (or technician or...) that showed 4:30 pm appointments every weekend starting today and ending the last Monday of February - 20 in all. Since the radiation oncologists had been talking about 6 or more weeks of treatment, I asked if this calendar represented the entirety of the planned treatment schedule or merely the part that had been scheduled to date. She told me she did not know. I asked who did know and when I could find out. She told me usually on Wednesdays after treatment I would have opportunity to meet with the doc and that I could ask them. Let me point out that this is the third conversation I have had with someone from this practice over the past week trying to get clarity about what my treatment schedule will be. She seemed to think it odd that I felt I should know now how long this treatment will continue. I find it bizarre that I am having so much trouble getting clarity on the schedule and even now it is now clear. And that I need to wait for another appointment and again the convenience of the doc before I can get an answer to that very reasonable question. Then I explained that I would need to reschedule the one for 4:30 next Friday 3/6 because I have a Urology appointment then. She seemed startled that I had anything interfering with the schedule I was just provided. I explained that since I had discussed at least 3 times that it would be best if I could come in the AM, I thought that a PM Uroloigst appointment was least likely to interfere with the schedule for radiation when I finally received it. I would have been glad to schedule around their appointments, but I had been unable to get any info on what that would be. I asked if I could reschedule that specific appointment today. It was explained to me that I can't do that until maybe Wednesday of next week. My request that I be able to schedule now so I could plan resulted in it being explained to me that I cannot receive so much very special treatment that it disadvantages other patients. I cannot describe how cynical I felt, but I suspect it showed on my face. I explained that I would have been happy to schedule the Urology appointment around the radiation therapy appointments but I was unable to get any information from this practice regarding when my radiation appointments would be, so I was forced to go ahead and schedule the Urology appointment. I also stated that it was not my impression that I had been getting a lot of special treatment. In fact it was my impression that this practice was more indifferent to the needs of patients than any other practice with which I had been associated as either a patient or a physician. She seemed to think I was way out of line, but asked specifically what time in the afternoon my Urology appointment was for that Friday. I had not brought it with me so was uncertain of my memory but I am pretty sure (can't check till i get back to my office tomorrow) that it is an exact conflict at 4:30. I did not tell her that, however. I told her that it did not matter what time it was since if we tried to schedule this appointment any time that afternoon I would have to complete the appt, travel back to Atlanta and from there up to Marietta GA in time for the next appointment. It is not feasible to plan this all in one afternoon. I need an appointment in Gainesville in the morning on that particular day. I have to wait until next Wednesday to see what slots are leftover to be able to schedule anything. I continue to be very unimpressed with this practice. They seem oblivious to patient needs. First treatment went smoothly I guess, although a bit uncomfortable. I now possess 3 tattos. And since the senior partner in the practice did come into the treatment room afterward to speak to me I took the opportunity to ask him if the schedule of 20 appointments I was given was the entirety of the treatment or only the part of the treatment they had scheduled to date. He checked and confirmed it was the entireity of the treatment - so it was possible and apparently even easy to confirm that. I did not bother trying to reschedule the appt for next Friday today. I will wait another week and just assume I will have to take that entire day off work. the good news is, now that I know my radiation treatments will routinely occur at 4:30 for the next month, i can plan around not needing to leave work until 3:30 or given rush hour commuter traffic, maybe 3 pm. That is helpful. AT last, something helpful.

Not a good soilder this week

The plan, on Dec 4 when I first met with the Radiation Oncologist who would manage the radiation therapy part of my treatment, was to complete 3 3-week cycles of chemo, then start the radiation therapy the next week. Maybe I misunderstood. But the multiple times I discussed this with my gyn oncologist, that was his plan and understanding too. And my chemo nurse Elizabeth says when they have done this complete-half-the-chemo-do-Radiation-Rx-then-finish-chemo thing that is how they have done it in the past. And that was the plan my gyn onc described to me when I met with him Thurs of the next to last week of my chemo, and he set up the appts for me to get a CT the following Thursday AM (thursday of the last week of my chemo) in time to have it available for the Rad Onc doc when I met with him in the afternoon. So imagin my surprise when i got to that appt and the Rad Doc was away doing mission work. And I was informed by his senior partner that after he returned the following Monday (last Monday) it would require at least 3 weeks for them to do planning before we could start. What? If any patient of mine with advance cancer that had recurred came to me and said "I have only completed half my chemo but I am going to just stop and think about things for 3 weeks" I would tell that patient "you are compromising your therapy and jepordizing your life". I dont see how this is different because the life in question is mine and the people deciding to stop and think are the docs. It is also not clear why it takes 3 weeks to plan. I know it requires lots of careful calculations of dosing, but surely these days they do that on the computer instead of by hand using an abacus. It was also not clear to my gyn onc's office, and it turns out that with enough calls from me to my gyn onc saying "I am not willing to take a month off, if we can't start radiation now I want to complete chemo uninterrupted and then consider whether to tag on radiation at the end" and enough calls from the gyn onc office to the rad Rx office - the planning could actually be completed in 3 days. It did require the doc to come in on his week day off to get started. Ask me if I feel a bit sorry for him. He had 2 months to plan before he went off on his mission trip. I dont want to sound indifferent to the health of people in the developing world but (1) my life matters too and (2) i have done work in that setting. Surgeons, immunizers, dentists and nurses are a god send. Primary care docs like me can't really do much good if we lack access to sophisticaed diagnostic testing and pharmacologic interventions. So now after an anguished (not an exaggerated description of my response) week and a series of distresed calls to my gyn onc office it appears straighten out. I start radiation therapy on Tuesday next week after only one week off (this week) with no therapy. The CT did identify ongoing hydronephrosis in the kidney that was freed up at surgery. I met with my primary care doc here at Emory about that today. He is arranging for me to be examined by a urologist next week for a decision on whether I need a stent placed (something like a hard drinking straw that will open up the strangulated area and keep it open). Comments from the Radiation Oncologist during our Dec 4 meeting or our meeting last week: "Well you are a doctor, what schedule do you think we should use?" This in response to one of my questions, an absurd question equivalent to a NASA physicist saying to me "Well you are a doc, what thrust do you think we need to get this rocket off the ground?" In response to my request for a description of a profile of the most common side effects and the liklihood of each one: " Well probably the worst you could get would be a malignant fistula. Ohh that would be terrible. They happen fairly often." Not according to the literature I have recently read. And what the heck? the usual response would be something like " the most common side effects are X and Y and maybe 5 - 10% of people experience them"... or some such. he does not need to tell me a malignant fistula could be awful, I am aware of that. In response to my statement that I have an appt with my internist to evaluate the need for a urologist consult and stent: " I think that is a good idea. As you know, some people have no problem with stents and others are very much bothered by them." No, I was not aware that stents were an ongoing source of discomfort for many people. What the heck. Is he trying to place that idea in my mind? I dont know if this guy is just socially very awkward or subtly sadistic guy who uses his position of authority to plant suggestions of bad things happening in the minds of people already dealing with potentially lethal diseases. I do know that I will not be recommending him or seeking his service as a physician again once i get through this radiation. And if I had it to do over I probably would go back to emory instead. Although My gyn onc office keeps telling me these people are very competent and they have never had this sort of experience with this practice before. Which raises the possibility that maybe he is a misogynist who is insecure about treating another physician. Fortunately i am pulling myself back together after seeing my primary care doc today, who is very efficiently and supportively managing my urology consult and who assures me I was not over reacting. And on the personal side, my beloved hound Balsam either liberated himself from my back yard or was liberated while I watched the STate of the Union address Tuesday night and has not been seen or heard from since. I have notices on 3 websties, paid his microchip company to send alerts to all vets and animal volunteer organizations in the area, and a local homeless man who soliicts work in our neighborhood spent the day walking door to door asking people if they had seen Balsam and tonight riding around helping me put up Missing posters with Balsam's photo all over the neighborhood. So people are good. And this weekend I have another meeting of the organizing committee for the reunion of the Mac class of1975 - a chance to have fun with old friends and relax a bit. Things are looking up. So I have been a pretty good soldier for 5 years. i guess I am due one melt down. Tomorrow is another day.

And here is the plan going forward -

Met with my doc last Thursday while in for lab check. Tomorrow is my third Monday (treatment day) in the 3rd 3-week chemo cycle. Here is the plan going forward: This coming Thursday I meet with the Radiation doc. We will hold on chemo following completion of this 3rd 3 week cycle next week and switch to radiation therapy for somewhere between 4 - 8 weeks starting either a week from tomorrow or 2 weeks from tomorrow. Exact decisions to be determined by my radiation therapy doc and hopefully transmitted to me during our meeting this coming thursday. Also on Thursday I will have the first CT scan since surgery, which will tell us more about whether and how to target radiation and influence whether and how we move forward with this plan. Following completion of the radiation therapy, which will require daily treatment 5 days a week, we will return and complete the remaining 3 3-week cycles of chemotherapy. So far I am doing well although my stamina had diminished and despite my vow to prioritize keeping up on personal issues like paying bills instead of prioritizing work during chemo, I am getting behind. I have to begin each day with a priority for what I will target. Yesterday I managed to empty the dishwasher and reload it by cleaning up the kitchen, but that was it. Today I am running the dishwasher and doing laundry. Have about 4-5 loads collected - uncertain whether I will get through all of them. Cleaning out the fridge is over due but may or may not happen today. Catching up on bill paying and paperwork filing is also over due and is beginning to appear to look unlikely to be completed today. Perhaps I can carry that material along and complete some of it while receiving chemo tomorrow...time and my energy levels/concentrating ability will tell. I continue to receive good support from my friends, colleagues and folks form church here for which I am grateful.

Cycle 3, moving into week 2

Last Monday was the first day of the first week of the third chemo cycle. It was, as I am growing used to, a new experience. To that date I had on more than one occasion had reactions to Taxol, the drug I receive weekly. But last Monday I had a reaction to the Carboplatin - the drug I receive only on the first Monday of each 3 week cycle and a pretty important drug in my treatment regimen. The reaction is hard to describe ... first I found myself very restless and spent much of the time standing up facing the nurses (because it seemed rude to face the other patients). I attributed this to worsening of the restless legs syndrome that I get in response to the IV benadryl, and also a worsening of the neuropathy in my feet. But it was hard to understand why these should be particularly worse last Monday. I went back and forth to the bathroom several times, and the third time I suddenly noticed the palms of my hands were all bright red. Then looking into the mirror I realized that my entire face was swollen and bright red. I went out and showed these to the nurses, who leaped into action shooting me up with (I think) more IV benedryl and steroids. Elizabeth (my chemo nurse) tells me that this reaction to carboplatin is more common with restlessness and I should try to sleep through the chemo. But I am not sure of the cause and effect. I did try to be still and sleep, wiht limited success. But I could slowly feel little shooting stars of relaxation in various parts of my body in response to the IV meds they gave me, and I suspect that perhaps the restlessness is less the cause than the sign of an on going reaction that led to the final red face and hands and whatever. Either way, i have decided that it is time to again start recruiting drivers for my Two drug Mondays so that the nurses can treat me with any drugs they want wihtout an iota of thought as to whether I can safely drive myself home. Another week, another adventure. Since Carboplatin is the corner stone drug for my treatment as long as my disease is sensitive to it, this reaction is not necessarily a good thing. Not really a good thing at all. Guess we will have to proceed with caution and hopefully it wont happen again. Beyond that life continues to move smoothly. My Arkansas childhood friend Barbara Breen is visiting from her current location in Iowa at Grinnell, which has been fun. And my sister called to say she and Joe are moved into their new place in Raleigh and when can they come help me. I meet with my doc next Thursday and will have a more certain understanding after that. But if we stick with the original plan, after the next 2 weeks complete the 3rd of 6 chemo cycles the plan is to switch to radiation therapy for 4-5 weeks, then return to complete the last 3 cycles. So Martha tentatively has the start of the next cycle marked on her calendar ... about early March... and I will count on her support them.

Cycle 2 Week 3 Transfusion 1

Today was the third and last week of chemo for Cycle 2, officially putting me one third of the way through completion of chemo. Today was also the first transfusion of this chemo regimen, resulting in a long day in Gainesville GA that did not see me back to Atlanta until nearly 10 pm. But I am much refreshed now that my hemoglobin is no longer hovering around 7. All went well and I look forward to moving on through cycle 3 over the holiday season. Balsam and I are looking forward to having the rest of the month off from work. Plans include minimal Christmas decorating this year, depending mostly on sweet smelling miniature rosemary trees and a few Santa hats on various statues around the house. I decided I deserved one Christmas service and yesterday morning at 8:45 seemed the best bet for a service not packed with people who staggered in despite coughing and sneezing. It went well and I got to take in the live manger, complete with a miniature Highlands Cow that reminded me of Scotland, adopted home of my nephew Judson and Blair Cowan. Christmas day will be split between visits with Aunt Marian Sprinkle Graves at her skilled nursing facility where Balsam loves to go for generous loving. Demented elderly people who loved dogs in their right minds continue to love them now, and generously share lots of things they held back on earlier in life (including partially chewed meat from their own mouths if we arrive at the right moment relative to meals), and time at home writing thank you notes, mailing Christmas letters and putting together the jig saw puzzel we recieved for Christmas from the Nebraska Thomas - Hutchison family last year. I look forward to a visit from my Arkansas cousins Ruth and Charles Thomas on Dec 26, and to bringing in the New Year with my local Gang of Girls who have rallied to provide incredible support through my surgery and chemo to date. I hope the holiday season and new year bring moments marked by the warmth of family and friends, the assurance of faith which ever faith you hold sacred, and renewed hopes for peace in this world for all of you.

Week 2 Cycle 2 done

Today Caroline McNeel drove me to chemo despite my insistance that i was perfectly capable of driving myself. I had a great deal of fun on the way up, the way back, and during the lunch at 2Dog cafe. Adn Caroline insisted that the time committment was great contribution toward finishing addressing her Christmas cards and had evidence to support the claim. And I am reconsidering Alice Rose's suggestion that perhaps in deciding to drive myself I was being a bit "Macho". I may be able to drive myself but it is more fun with company so I am again in the business of recruiting drivers. Or at least not rejecting offers since I can drive myself for now at least if I am driver=less. Chemo went well. Another much smaller taxol reaction - suggesting that I can anticipate needing more premeds (variations on benedryl and increasingly powerful steroids) and slower infusion times this time around. I commented to Elizabeth (the super chemo nurse who is largely the reason I stay with this practice instead of returning to Emory) that my stamina seemed to be decreasing faster this time around and I occasionally get dizzy when I stand up, which did not happen until much later in the chemo experience last time. I wondered if my blood counts were dropping. Elizabeth tells me it is common the second time around to have less stamina in response to chemo and to experience more side effects more often than on first exposure to the drugs. So that is that. I continue to try to accomplish a thing or two a day - usually successfully but am already sinking into the napping in front of the TV thing. And my interest keeps lagging for the Patricia Cornwall book I am reading - but I think that may have more to do with the trend she has established for abandoning plot for instead detailing second by second interactions of the character so i have been reading for days and am 3/4 way through the book but we are still less than 6 hours further along in the actual story than when we started. Perhaps the author has developed an obsesssive disorder? if this is an intentional change in technique I think I may start getting her books at the library in the future to save that feeling that I need to read the entirety of the book I bought to justify the expenditure. On another note, in response to the questions about my Christmas plans - I have not figured them out yet. I have not spend actually a lot of time thinking about it, although I should. Probably I will stay in Atlanta since Thanksgiving has become our big extended family holiday while Christmas is now precious time for my siblings nuclear familys to reunion. My habit is Sylva, but this year I wont be working at Cherokee and the energy required to drive 2.5 hours for the Christmas Eve service and visits with friends and open house seems a bit too much. And I need to be in ATL for labs on Friday. Maybe an open house Christmas Day evening for anyone around who wants to bring leftovers and drop by for dominos? STay tuned. For the moment I am getting chemo and Balsam (as of vet visit today) is getting treated for dermatologic allergies and an ear infection, all of which is easiest to maintain from home. Dog Hobble Hill - although in reciept of a Certificate of Occupacy - is still not completed of interior work or ready to move more furniture in than the one bed I have already deposited. So I suppose Balsam and I could spend Christmas there but it would be grim and lonely since i can't take my friends along yet. So probably staying in ATL but plans yet to be developed. Open to suggestions? Tomorrow's challenges: (1) try to finish paying all bills and filing paperwork. (2) Get Balsam to the vet for medicated bath. (3) Get into work to find out whether I have a replacement Blackberry yet. (4) draft a Christmas 2014 letter? STay tuned.

Start of second 3 week cycle of chemo

Sorry I have been negligent in notifying folks about this surgery and chemo in advance and keeping them updated through this blog. To be honest surgery and chemo is just not as exciting and adventurous the second time around... Yesterday I had the first treatment of the second 3 week cycle of chemo. This means I was dosed with Carboplatin and Taxol (what I refered to as my Flower Power drug during my first treatment because it is derived from the Yew tree. Things went well. I had a Taxol reaction during the last week of my first 3 week cycle but we managed it with benedryl and decadron and slowing the drug infusion and all was well. When I say "we" I really mean "they", and specifically Elizabeth the wonder chemo nurse. See posts from first chemo in 1009-10 for come complete descriptions of these drugs and the process and Elizabeth. My contribution was mostly interrupting a conversation someone else was having with Elizabeth by declaring loudly "Elizabeth sorry to interrupt but something is wrong. I can breath fine but my chest has suddenly tightened and now I am starting to have sharp throbbing pains in my back." It was a call for help but it makes me feel empowered to think of it as a carefully crafted description by a medical professional that set the proper response into motion. Even if I had no idea whatsoever what the proper response would be. I knew the professional i was consulting (Elizabeth) would be on top of it and she was. I was also started on neurotin, a neurtropic drug mainly used to treat seizures. But also used to treat the neuropathy that I developed during my first chemo. That neuropathy improved but persists and probably I would eventually need it during this round for that reason. But it was started earlier because it also is used to treat restless legs syndrome which I get in spades due to the Benedryl. Seems to be helping, So far I have not wound up upside down in my chair or otherwise entertaining the other patients while embarassing myself by odd behavior (probalply due to Elizabeth's wise deicision not to use benzodiazepams). Last thursday I also met with a Radiation Therpist - Dr. Grifffith in Gainesville to discuss the possibility of inserting a Radition Therapy treatment into the chemo. This is not standard and unlike my first treatment it is also not part of a randomized clinical trial. But given the localized nature of my recurrence, adding RT to that spot may increase the possibility of long term remission or even ablation leading to cure. I think it is a risk work taking. WARNING the paragraph that follows may be of interest to medical professional but too graphic for others. Please feel free to skip. It also is becoming clear that I have one of the possibile complications of this surgery - a leak into the vagina that either resulted from the surgical efforts to remove all the adhesions (scar tissue) that was trapping the recureent tumor (situated just between the vagina, bladder and intestine and adhereing it to all while strangling a ureter leading to hydronephrosis). Or it may be due to tumor residual not removed at surgery. The apperanace of a little nubbin visible during the vaginal exam suggests the latter. Since the treatment approach at this point would be the same whether this is a surgical complication or a maliganent complication, which would be to continue Chemo and RT to get rid of the tumor and hope for healing by secondary intention (allowing the wound to heal itself without surgical intervention0 for the surgical part, we decided not to repeat the vaginal exam for purposes of a biopsy. in addition to driving up the cost without changing the approach to treatment (taxpayers applaud), it was painful and upped my use of hydrocodon from 1 - 2 per week to 4 within 36hours. So the plan is full speed ahead. I and my medical professional have decided that I can drive myself safely to and from chemo as well as labs and i am implementing that plan. Instead of recruiting drivers ( stuck having to spend a day in Gainesville) i will be recruiting a list of folks willing to be on a call list in case something during treatment suggests I may not be safe to drive myself home in the evenings. That will be easier for everyone. Although one of my driver volunteers suggested that I might be being too macho and offered to drive me anyway. I do not reject good company of a driver when offered! So Alice Rose I look forward to your company during a future chemo session and thanks for driving. So on ware and upward. it looks like the course from here will be 3 rounds of chemo (already in week 2 of the second round) and then about Jan 12 - 15 switch likely to 4-5 weeks of radiation therapy (RT) followed by the additional 3 cycles of chemo - taking treatment through April. Sigh and probably forceing me to miss my nieces wedding March 21. But as as act of optimism I have ordered the black tie equivalent of the PHS officer uniform (she is marrying a Navy officer). If I can't be there in Rhode Island maybe they can skype me in for some part of the ceremony or reception. No point in missing an opportunity to make it clear that I outrank the groom and most of his friends (just in case). Kidding on that - she made a great choice and I see no need for shows of force. Still ... once I learned not to giggle when military folks snap to attention and salute it became sort of fun now and then to be treated with respect just based on the rank on the sleeve. Stay tuned. I will try to be better about updates but now I have to go to work.

draft apparently written

Second Chemo today. Wonderful local playwright Karla Jennings volunteered as driver. Gave her a chance to avoid more diverting activities (like writing plays) and instead focus on grading papers. Gave us a chance to catch up.  i loved hearing about her new play with