Takin' Care of Business

The past few days have been busy. I still haven't cleaned out my email inbox. But I guess I got a few other things done. I took Eddie to Portland on Friday - we went to Buffalo Wild Wings so we could play a trivia game against other customers. Borders had a trivia game, too, but Eddie only read two of about 20 of the series. He ended up in 2nd place.

Scott and I have been rearranging furniture in the house.

I've been cleaning house - and as I stated in my earlier post - I'm washing clothes and am on lice and poison-oak rash spotting duty.

Thank goodness I'm not teaching. I've got more time for this stuff.

I have a CT scan on Wednesday. My wheezing has decreased - it's almost gone, although it comes back if I have processed sugar. I *think* that enlarged lymph node in my left armpit is smaller. I had to search some to find it. I have been doing more qi gong and visualization and while I'm not taking the cordyceps alone, I am getting a slightly increased dose of it with my mushrooms - I increased that dose about a week ago. The feather mattress top is off the bed, too. Not sure if that helped or not. I think pollen is decreasing here in the Valley - although my mom's and my brother's allergies were still bad last week, when I felt my symptoms decrease.

In other words, takin' care of business.

Am I Grasping at Straws? : )

I have been wondering, over the past week or so, whether or not the goose feather mattress topper I bought is causing this slight cough that I have. I bought this goose feather mattress topper on March 30, 2009, because my all natural latex bed is a bit too firm for my back.

I had my CT scan on April 7, 2009. Dr. K called me with the results with on April 14, 2009, in which they found lung nodules on my left lung. I began noticing a slight cough with a slight wheeze two days later, on April 16, 2009.

Lung nodules can be caused by a variety of things, including infections and inflammation.

Maybe, just maybe, I am allergic to that feather mattress topper. Maybe the continued exposure finally resulted in finally getting a cough a couple of weeks later.

Or, perhaps I have slight allergies to mold or mildew, which can be especially bad here in the mid-Willamette Valley during the winter months. Then, the feathers (which were sterilized) in the mattress topper made things worse.

Or, perhaps I'm allergic to dust mites and since it took a couple of weeks for dust mites to grow in the feather mattress topper.

So, respiratory allergies cause inflammation. Perhaps the inflammation caused the lung nodules.

How can I get to the bottom of this?

First, I took the feather mattress topper off the bed today.

Second, I just might take C.'s advice (the nurse who called me today) and make an appointment with my primary care physician and see if I can get tested for allergies as well as tuberculosis.

Third, maybe I am allergic to mold. There is some more mold growing on my bathroom ceiling.

I've never really been bothered by allergies. However, my mom is very allergic to a lot of things - she gets hay fever, she has asthma, she's allergic to animal dander and metal, as well as the sun. My youngest brother also has hay fever. My sister breaks out into a rash in the sun. Several years ago, during a particularly high pollen year, my eyes burned. So, I just may be susceptible.

In past years, I've gotten a cough that hangs on for weeks, usually in the winter time.

I also had a cough that hung on for a couple of months last summer, when I was doing radiation treatments.

If I do, then I think it's highly probable that the lung nodules are caused by allergies.

I'll keep you posted.

A Visit with Dr. K

I saw my oncologist, Dr. K, yesterday. We talked mostly about the lung spots on the CT scan. He even showed me the CT scan, which was kinda cool. Here were the questions I asked:

1) How likely is it that the lung spots are metastases if my tumor markers are low? He said that it is "less likely" than if my tumor markers were going up. We then looked at the history of my tumor markers. The CA15-3 was as high as 36 in March 2008 and that was when we found that it was in my skin and my bones in February 2008. It was 18.4 last month. Anything above 33 is suspect. But this is just a gross measure . . . sometimes it happens that you have active cancer but the markers are still low. Still a low tumor marker is usually a good thing.

2) The CT scan also found that I had one or two enlarged axillary lymph nodes in my left arm pit. I've been able to palpate one of them and when I do, it moves around quite a bit. I told him that I'd read that if those lymph nodes are enlarged and, generally, if it is cancer, those lymph nodes are hard and stationary - they don't move very well because the cancer causes a fibrous mass in the node. Or something. He wasn't able to palpate it very well. Lymph nodes can become enlarged with any kind of infection. He agreed that generally nodes with cancer do not move, so the fact that it moves quite a bit is a good thing.

3) Would those lung spots cause the coughing that I've been experiencing since I found out about the lung spots? He said that those lung spots are "so small" that I wouldn't notice anything in terms of coughing or breathing. He asked if I experienced shortness of breath when exercising. I haven't really. His guess is that my coughing and slight wheezing that I have is related to allergens. The Willamette Valley is notorious this time of year for hayfever. Lots of pollen in the air. However, I still had this slight cough while in northern Norway, which was pre-pollen season there. On the other hand, I did eat a lot of processed sugar while in Norway which can cause some phlegm and a cough.

4) Where are the lung spots? My spots are nodules inside the lungs, not on the pleura. They were located at the outside of the major blood vessels, more on the periphery. The major blood vessels were well lit up and on the CT, I could see them get bigger and then smaller out at the ends of the vessels. These spots were located beyond the ends of the vessels, so they weren't blood.

5) What is the likely progression of disease? I said that it was in my breast, then in the skin and the bones. He stated that cancer like mine, which was spreading via the lymph and the blood, would be somewhat more likely to go to the pleura, and then it would be easy to go to the lungs. I also mentioned that it seemed strange that my cancer was in the right breast, but that the spots showed up on the left side. He nodded because it would seem logical that the cancer would go to the right lung first. However, he does know of examples where the cancer was in one breast and they didn't find cancer in the lymph nodes on the same side, but in the opposite side. He asked, "so why did it pass through all of these other places and then decide to stay there in the opposite side? We really don't know enough about the biology."

6) When would cancer go to the liver and the brain? He said that different varieties of cancer cells like to grow in certain environments. So, cancer that's in the blood and lymph is more likely to go to the lungs, but that the cells would have to "change their code" (which I assume meant genetic code) in order to want to invade the liver and the brain.

7) What else could cause the lung spots? He admitted that it could be a lot of things. He mentioned fungal infections and gave me several names of different diseases caused by fungi. One is histoplasmosis, which I've heard of before when I worked as an assistant for a retinal doctor. He said that people in certain regions, like the Ohio River Valley, have high rates of fungal infections, like 50%. These fungal infections can lodge in the lungs but people never have any symptoms, other than the nodules in their lungs. Lots of people in the Ohio River Valley (I think) have CT scans that look like mine.

8) Those spots weren't there in August 2008, and 8 months later, they are there and one is 1cm. My first cancer was 2cm and they said that it had been growing for 8-10 years and was "slow-growing". This cancer was "medium-growing", and while it was more aggressive than the first one, it wasn't the fastest growing tumor. So, how likely is it that a tumor would grow to 1cm after just eight months? He said it was certainly possible that it could grow that quickly, but when I said something about slow or medium-growing, he just shrugged his shoulders and said that there was much that they don't know about the biology of the disease.

And, finally, given all that we discussed, I asked 9) what is the likelihood that these spots on my lungs are cancer? His answer? A 60/40 chance. I asked, "do you mean a 60% chance that it is cancer?" and he said, "yes". I replied, "Well, with what you've told me, I think it's more likely to be 60/40 that it isn't. Even, 80/20 that it isn't cancer". He smiled, which implied that he liked my positive thinking.

He suggested that I start doing visualizations and visualize those spots shrinking. He doesn't want me to change my meds at this point - so I'm still taking Tykerb and nothing else. I'll have a CT scan in early July and then another appointment with him on July 9th. We'll see what happens then. Next week, I have another Zometa treatment and then will have my tumor markers measured.

So, the past few nights, I've been trying to start a visualization routine. I go through these relaxation breathing exercises and fall asleep before really starting to do that. I got a bit farther last night. I imagined every breath I took in as a cleansing breath. Sometimes, I held the breath and imagined the air as a kind of "roto-rooter" cleaning out anything bad, like a fungal infection or little tumors. Then, when I let out the breath, I let it all go. My goal is to take a lot of breaths like that everyday, imagining something similar. Sometimes, the "roto-rooter" was a cleansing light (which was something I read within the last week in one of my books).

I really would like to get hypnotized - two of the books I'm reading by Andrew Weil and Brian Weiss talk about hyponosis. Visualizations are easier under hypnosis . .. but how do I find a hypnotherapist that I can trust?

Well, that's something to work on. In the meantime, reading rough drafts of student papers (this class did a great job on Wednesday doing skits, where they pretended they were aliens observing American culture; they did a great job!) and making some final revisions to an article. I will also meet with my incoming Ph.D. student today. This week-end - finish the mosaic and more putzing around the house. I think we're going to have a garage sale next week-end.

How am I feeling? Happy and content. It's sunny outside. I'm getting my work done, both at home and at work. My son is in good spirits. My partner is having some issues with his daughter, so he's stressed about that, but he seems to be enjoying massage school. I have a job and the rhodies and roses and irises are blooming. What more can one ask for? (Well, other than being free of cancer!)

A Relaxing Evening with American Idol

After a very busy evening yesterday doing housework-related stuff, I can relax this evening. I still need to put some clothes away and balance my checkbook and I might work on an article, but for the most part, I plan to stretch and watch Idol.

I saw my acupuncturist today. She worked on my lung meridian. I also mentioned this low back ache that I have on the left side - where the hip bone connects to the sacrum (I think). She did some cupping there on the back and gave me some ideas for stretches that might help. She then speculated that I must be holding on to some emotional thing that is causing my lung congestion. I thought about what I might be holding onto: one is worry, both about the lung situation as well as my family's financial situation (my dad and my brother cannot find work) and the other is some guilt about something that I'm not at liberty to talk about on the blog. So, my goal is to try to let go of some of that and then do some of these stretches.

I then saw my plastic surgeon, Dr. H. His wife performs the laser removal of hair, so next week, I go in to see her and she will remove the "pubes on the boob". Dr. H said they weren't really pubes as they weren't dark and/or curly, but it was definitely hair that originated near that general locale. Also, while his wife is doing laser for the hair removal, they will also use the laser on the TRAM flap scar. Both procedures together should take about 20 minutes. We may do this one or two more times, but it really should be a snap. It's considered part of the whole procedure so no out of pocket expense for me. Yay!

Also, on the abdominal scar, on the left side, the end of the scar is pointed. Probably in late summer, when I'm ready, I can go in for another outpatient procedure and Dr. H will trim that up in order to smooth out the line on that area. It sorta looks like I have a pencil poking out of the skin there - not quite that drastic, of course, but there is a small pointed area of skin. This procedure will only take about 45 minutes to smooth it out. They basically snip off the fat and then they will stitch it up again. There's about a month recovery time, so they suggested that I wait until all my summer activities are over - softball, volleyball, and I may even be able to take Eddie to the swimming pool this year.

All in all, a good couple of appointments!

Okay, on to the stretches!

Conversation with my Colleague

As I posted a few days ago, I'm not entirely convinced that those lung spots on the CT are cancer. I chatted about it today with my colleague, who has a Ph.D. in genetics (I think) and whose brother is an MD (I think). S. has been my source for medical research reports - he'll read them and then explain the nitty gritty details for me. (S., I know you read the blog - please correct me!)

First, I asked S. about what he knew about the relationship between tumor markers and metastases, particularly in the lungs. I asked how likely it would be that I would continue to have low tumor markers and still have a metastases. In the end, from what I understand from him, it would be highly unlikely to have a lung metastases with my low tumor markers.

Second, I mentioned how unconcerned Dr. K seemed to be when we talked on the phone last week. He had the CT report for six days before calling me, which suggests that there was no urgency. He said that he just wanted to stay the course in case of my treatment regimen (Tykerb). If it grows in the next three months, then we consider Xeloda. But he said "if". He also told me to go ahead and keep with my long-term planning with work (i.e., years). He gave me the impression that he didn't expect the spots to grow at all. As I reflect back on the conversation, Dr. K seemed really unconcerned.

Third, I mentioned to my colleague that I had a 1cm spot and 2 4mm spots. Now, my first bout with cancer, I had a 2-2.5cm tumor that the doctors said had been growing for 8-10 years (slow-growing). This time, I had tendrils that extended out 5cm and then had spread to my skin and I had bb-sized ones in my bone marrow, which Dr. K estimated had been there for "months". This cancer was "medium growing". My point is that how did a 1cm lesion grow so quickly in 8 months? My cancer wasn't fast growing - those spots weren't on the CT scan in August. If my latest cancer was "medium growing", I just have this impression that it wouldn't be so big so quickly.

My colleague and I then talked about how perhaps I picked up some kind of infection that's affected my lungs while I was on the airplane to Norway, which would show up as spots on a CT scan. He also said that the spots could be caused by many different things.

Then, about 30 minutes later as I sat in my office preparing for class, S. came into my office and asked me if the CT scan found anything in the liver. When I replied that it didn't, he said that, in general, most breast cancers progress to the skin or the bones first, then the liver, then the lungs, then the spine, then the brain. It doesn't very often happen that it would go to the lungs before the liver. So, again, it's highly unlikely, since my liver is clear, that those spots are cancer on my lungs.

So, all in all, a good conversation about the likelihood that there is cancer in the lungs - not very likely at all. It made me feel better. I was feeling a bit down this morning as I walked to work - I didn't really want to be at work both because it was gorgeous out and because I'm burnt-out still from teaching; I got to thinking about how long it was going to seem before my next CT scan (and having to live with uncertainty); and I still had to grade some papers (the worst part of my job). It was a Monday, for sure. The conversation with S. perked me up. Thanks!

P.S. I changed my "label" from "lung mets" to "lung spots"

After finishing a post, I usually try to put labels on them, so that it'll make it easier to find posts on particular topics. I put "lung mets" on my post from last night, but after doing a bit of web surfing and thinking about having low tumor marker numbers and the possibility that these spots are an infection or inflammation of some kind, I decided that since we don't know for sure they are lung mets, it'll be better to call them "spots". Takes away their power. Reprograms the mind.

Good night again!

Doing Okay

I woke up today and decided to go to work. I decided that if those spots in my left lung are cancer, they've been there for awhile (weeks or months) and I've been feeling happy. I was ignorant of these spots, yes, but I was still hopeful for the future. So, the only thing that changed was the knowledge that they were there. Might as well just continue on as I have, enjoying my life to the fullest. I also got to thinking that it is certainly a reminder to slow down again.

I also got an email from Anna (at NSF) and one of the things in the email had to do with the lack of participation of indigenous people and women during presentation for the International Polar Year. Sooo, it reminded me that there is still a lot of work yet to be done in terms of including indigenous peoples and women in scientific undertakings. It reminded me that I'm first and foremost an anthropologist, too. Not a cancer patient. Perhaps an anthropologist who happens to have cancer. But it still reminded me of who I am and the reasons why I do the work I do. Got that fighting spirit back.

So, other than shedding a few tears with my office staff at this latest news (they're both struggling with budget woes here in Oregon - lots of staff layoffs on the horizon), I managed to have a more or less normal day. Teaching in my first class was fun - my students seem to be interested and engaged and I always feed off their energy. Again, it served to remind me why I'm here. My second class went well, too.

I had a late meeting (complicated by my walking the wrong way across campus to get to where my car was parked), but when I came home, I was able to visit with Scott (he and Rick and Chris, Rick's son-in-law) tore down this horrible old fence that was falling down in my yard. Scott has thankfully taken over managing the building of a new fence - that whole side of the yard will look much much better when all is said and done. I also spent time with Eddie. Scott and I enjoyed teasing Eddie, then I helped him with his homework, and then we played on his Big Wheel - spinning to get higher scores. That was fun, too. Then, it was American Idol. My favorites are Allison and Anoop and Adam and Danny.

So, tonight, as I was responding to another blogger on her blog about my latest news, the question came up about how is it I have lung spots when my tumor markers are well within normal range. I thought I'd heard that tuberculosis rates were up either in Alaska or in the Lower 48, and since in recent years, I've struggled each winter and even last summer with a persistent cough - I catch a cold and my cough hangs on and on for weeks - I got to wondering if it was tuberculosis. It does show up on a CT scan. Might I have it? I think my mom may have had it at some point and I will call her tomorrow and ask. I was just in Alaska in October.

I then googled "tuberculosis ct scan" and found a discussion group where the people also talked about having these spots on the CT scan, only to have their biopsies come up negative for cancer. These spots can be caused by simple inflammation or infection. My question is what is the relationship between this intermittent persistent cough that I get (this past winter mid-to-late Jan and for about a week or so after my surgery), for about 8 weeks last summer, last winter for several weeks, the winter before that for several weeks, etc.

So, I'm not entirely convinced it is cancer. Low tumor markers sorta argue against it. Having some kind of chronic, intermittent cough might be related to period inflammation that clears up and comes back.

I'm still going to do the prudent thing - take Tykerb again - and will also begin taking a Chinese herbal mix (Paris 7) that helps with lung health, in general. My acupuncturist says that it'll help with lung infections, inflammation, and cancer, so it can't really go wrong and there aren't really any side effects. She reminded me of a qigong move (a breathing exercise) that emphasizes lung health. And, get good rest.

So, I got a plan. My plan includes not seeing anything on a CT scan in three months. Thank you, jmoore4you, for telling me that your spots cleared up. That's what mine are going to do, too.

Good night everyone. Sweet dreams.

CT Scan News - A New Excuse to Say No at Work!

Dr. K finally called me late this evening. No news was not good news. It just wasn't urgent news.

Apparently, I have three little spots on my left lung. The spots on my bones are still there - they aren't bigger and also there was the same amount of spots. The little spots on my lungs are 1cm and two 4mm spots.

Crap. This means I start taking Tykerb again. We will do another CT scan in three months, if the spots have grown then we bring Xeloda back into the mix.

F&*K. I was not expecting that news.

Dr. K did say that while we haven't stopped the disease, we have slowed it down quite a bit. He really didn't expect me to be doing as well as I am. He told me that I look healthy. I am mentally healthy. He also said that I should continue living my life as I have, making plans to serve on Arctic research committees if I want to, traveling, etc.

There is a chance that these spots were caused by some infection - that they are scars. He said that sometimes, after pneumonia or bronchitis, spots like these show up on CT scans. However, my last CT scan 8 months ago did not show these spots. He double-checked. So, we suspect cancer.

This is when you start second-guessing all of your decisions - like going off of Xeloda in December and trying this little experiment to not take Tykerb. But like I told Scott just now, I can't sit around regretting those decisions. I made the best one I could make - I made the one that was right for me. Dr. K sorta expects that the next CT scan will show these three spots with no changes. They could be that way for years.

So, I start Tykerb again tomorrow. I will also contact Brodie and see if Chinese Medicine might have something to add to the mix.

I don't want to teach tomorrow. I sorta feel like crawling into a hole. It's gonna be hard to act like everything's normal when it isn't.

Update (10 minutes later!) - I just added the subtitle "A New Excuse to Say No at Work" - I'm trying to regain my sense of humor and equilibrium. Bear with me, please!

Well, shit anyway.